Real-World outcomes of thrombectomy for distal medium vessel occlusions in the middle East and North Africa region: A multicenter registry analysis.

Authors

Ossama Yassin Mansour, Atilla Ozcan Ozdemir, Erdem Gurkas, Tamer Hassan, Farid Aladham, Ibrahim Alnaami, Hosam Maher Al-Jehani, Abdulrahman Alshamy, Faisal Alghamdi, Ozlem Aykac, Mohamed Khaled Elwia, Hany Hamadani, Asim Javad, Mahmoud Galal, Mohamed Ghorbani, Nadia Hammami, Mohamed Habib Alaa, Farouk Hassan, Syed I Hussain, Yahia Imam, Seby John, Ahmed Ossama, Amina El Khamlichi, Amr Mahmoud, Mostafa Mahmoud, Nada Nasr, Umair Rashid, Salma Said, Abdulmonem Saied, Mohammed Wasay, Hany Zaki Eldeen, Ashfaq Shuaib

Published in

Neuroradiology. Oct 25, 2025. Epub Oct 25, 2025.

Abstract

Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region.
The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022-2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0-2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage.
Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25%), baseline secondary (50%), and iatrogenic secondary (25%) DMVOs. Overall successful recanalization was 69%, with primary DMVOs achieving higher rates than baseline secondary (78% vs. 59%, p = 0.046). Good functional outcome occurred in 54% overall, with no significant differences between subtypes (primary 59%, baseline secondary 51%, iatrogenic secondary 54%, p = 0.661). Stent retriever achieved highest recanalization (85%) followed by combination (74%) and aspiration (45%, p = 0.046). Independent predictors of poor outcome included age > 75 (aOR 2.34, 95% CI 1.18-4.64), NIHSS > 15 (aOR 3.12, 95% CI 1.45-6.71), and unsuccessful recanalization (aOR 4.89, 95% CI 2.31-10.35). Cost-effectiveness analysis across MENA income levels yielded ICERs of $26,875-$71,333/QALY, exceeding regional GDP thresholds. The modest numerical difference in outcomes (54% vs. 45% historical controls) does not establish clinical benefit given neutral randomized trial results.
Real-world DMVO thrombectomy outcomes closely mirror recent randomized trial results showing limited clinical benefit compared to medical management across diverse healthcare settings, with prohibitive economic costs that challenge routine implementation. These findings support highly selective application focusing on younger patients with moderate deficits and primary occlusions.

PMID:
41137925
Bibliographic data and abstract were imported from PubMed on 25 Oct 2025.

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