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<meta name="DC.Title" content="Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3230" />
<meta name="DC.Date" content="2012-08-09" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions.

MATERIALS AND METHODS: Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of &gt;5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group).

RESULTS: Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%–75% CI, 1.5–13) and 3 points in the IVT group (25%–75% CI, 1–5) ( P = .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6–89.1; P &lt; .02). No symptomatic intracranial hemorrhage was observed.

CONCLUSIONS: IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.

### Abbreviations

ASPECTS
:   Alberta Stroke Program Early CT Score
CI Score
:   confidence interval
IA
:   intra-arterial
IES
:   IV-endovascular strategy
IVT
:   IV thrombolysis
mRS
:   modified Rankin Scale" />
<meta name="DC.Contributor" content="J.-F. Vendrell" />
<meta name="DC.Contributor" content="R. Mernes" />
<meta name="DC.Contributor" content="N. Nagot" />
<meta name="DC.Contributor" content="D. Milhaud" />
<meta name="DC.Contributor" content="K. Lobotesis" />
<meta name="DC.Contributor" content="V. Costalat" />
<meta name="DC.Contributor" content="P. Machi" />
<meta name="DC.Contributor" content="I.L. Maldonado" />
<meta name="DC.Contributor" content="C. Riquelme" />
<meta name="DC.Contributor" content="C. Arquizan" />
<meta name="DC.Contributor" content="A. Bonafe" />
<meta name="article:published_time" content="2012-08-09" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of &amp;gt;5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%–75% CI, 1.5–13) and 3 points in the IVT group (25%–75% CI, 1–5) (&lt;i&gt;P =&lt;/i&gt; .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6–89.1; &lt;i&gt;P&lt;/i&gt; &amp;lt; .02). No symptomatic intracranial hemorrhage was observed.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="R. Mernes" />
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<meta name="citation_author_institution" content="From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France." />
<meta name="citation_author" content="C. Arquizan" />
<meta name="citation_author_institution" content="From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France." />
<meta name="citation_author" content="A. Bonafe" />
<meta name="citation_author_institution" content="From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France." />
<meta name="twitter:title" content="Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions.

MATERIALS AND METHODS: Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of &gt;5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group).

RESULTS: Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%–75% CI, 1.5–13) and 3 points in the IVT group (25%–75% CI, 1–5) ( P = .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6–89.1; P &lt; .02). No symptomatic intracranial hemorrhage was observed.

CONCLUSIONS: IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.

### Abbreviations

ASPECTS
:   Alberta Stroke Program Early CT Score
CI Score
:   confidence interval
IA
:   intra-arterial
IES
:   IV-endovascular strategy
IVT
:   IV thrombolysis
mRS
:   modified Rankin Scale" />
<meta name="og-title" property="og:title" content="Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2012/08/09/ajnr.A3230" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions.

MATERIALS AND METHODS: Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of &gt;5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group).

RESULTS: Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%–75% CI, 1.5–13) and 3 points in the IVT group (25%–75% CI, 1–5) ( P = .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6–89.1; P &lt; .02). No symptomatic intracranial hemorrhage was observed.

CONCLUSIONS: IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.

### Abbreviations

ASPECTS
:   Alberta Stroke Program Early CT Score
CI Score
:   confidence interval
IA
:   intra-arterial
IES
:   IV-endovascular strategy
IVT
:   IV thrombolysis
mRS
:   modified Rankin Scale" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node49988--5" data-node-nid="49988" id="top-node-49988--61782256676" data-pisa="ajnr;ajnr.A3230v1" data-pisa-master="ajnr;ajnr.A3230" data-apath="/ajnr/early/2012/08/09/ajnr.A3230.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.-F. Vendrell</span>, <span class="highwire-citation-author" data-delta="1">R. Mernes</span>, <span class="highwire-citation-author" data-delta="2">N. Nagot</span>, <span class="highwire-citation-author" data-delta="3">D. Milhaud</span>, <span class="highwire-citation-author" data-delta="4">K. Lobotesis</span>, <span class="highwire-citation-author" data-delta="5">V. Costalat</span>, <span class="highwire-citation-author" data-delta="6">P. Machi</span>, <span class="highwire-citation-author" data-delta="7">I.L. Maldonado</span>, <span class="highwire-citation-author" data-delta="8">C. Riquelme</span>, <span class="highwire-citation-author" data-delta="9">C. Arquizan</span> and <span class="highwire-citation-author" data-delta="10">A. Bonafe</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2012,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3230 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-49988--61782256676" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.-F. Vendrell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.-F.%2BVendrell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vendrell%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.-F.%2BVendrell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R. Mernes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BMernes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mernes%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BMernes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">N. Nagot </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BNagot%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nagot%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.%2BNagot%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D. Milhaud </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BMilhaud%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Milhaud%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.%2BMilhaud%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">K. Lobotesis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BLobotesis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lobotesis%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.%2BLobotesis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">V. Costalat </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BCostalat%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Costalat%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AV.%2BCostalat%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">P. Machi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Neuroradiology (J.-F.V., K.L., V.C., P.M., I.L.M., C.R., A.B.), Neurology (R.M., D.M., C.A.), and Medical Informatics (N.N.), Montpellier University Hospital, Montpellier, France.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BMachi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Machi%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BMachi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">I.L. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions.</p></div>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of &gt;5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group).</p></div>
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<p id="p-3"><strong>RESULTS:</strong> Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%–75% CI, 1.5–13) and 3 points in the IVT group (25%–75% CI, 1–5) (<em>P =</em> .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6–89.1; <em>P</em> &lt; .02). No symptomatic intracranial hemorrhage was observed.</p></div>
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<p id="p-4"><strong>CONCLUSIONS:</strong> IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.</p>
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<h3>Abbreviations</h3>
<dl id="def-list-1"><dt id="def-item-1">ASPECTS<span class="def-item-dt-sep"></span></dt><dd>Alberta Stroke Program Early CT Score<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CI Score<span class="def-item-dt-sep"></span></dt><dd>confidence interval<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">IA<span class="def-item-dt-sep"></span></dt><dd>intra-arterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">IES<span class="def-item-dt-sep"></span></dt><dd>IV-endovascular strategy<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">IVT<span class="def-item-dt-sep"></span></dt><dd>IV thrombolysis<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale</dd></dl>
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      <div class="highwire-cite-title">Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.-F.</span> <span class="nlm-surname">Vendrell</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Mernes</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Nagot</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Milhaud</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Lobotesis</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Costalat</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Machi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">I.L.</span> <span class="nlm-surname">Maldonado</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Riquelme</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Arquizan</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Bonafe</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2012, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3230 </span></div>
  
  
  
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