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Comment & Response
April 2017

Response to Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment—Reply

Author Affiliations
  • 1University of Texas at Houston Stroke Center, University of Texas Health Foundation, University of Texas Health Science Center, Houston
  • 2Department of Neurology, Cleveland Clinic Health Foundation, Cleveland, Ohio
  • 3Department of Neurology, WellStar Hospital, Marietta, Georgia
JAMA Neurol. 2017;74(4):488-489. doi:10.1001/jamaneurol.2016.6165

In Reply We thank Silver and Morelli for their interest in our article. We agree that is it always of interest to look into the side of the lesion, specifically into dominance more than right vs left. Although this was not addressed in the recent randomized clinical trials,1-5 we looked into this aspect in our initial analyses. When performing our univariate analysis, we looked at factors that independently correlated with good outcomes with endovascular therapy (EVT) as detailed in the Results section of our article and further discussed in eTable 2 in our Supplement. The side of the lesion was tested in the univariate analysis and was not statistically significant (odds ratio = 0.98; 95% CI, 0.54-1.78, P = .96), hence, we did not include lesion side in the multivariate analysis and article. However, to address Dr Silver’s request, we looked at treatment effect in each side, and this enforced analysis did not show a difference in endovascular thrombectomy treatment effect based on the lesion side, left vs right (left, odds ratio, 3.95 [95% CI, 1.90-8.40; P < .01]; right, odds ratio, 3.30 [95% CI, 1.30-8.10; P < .01]).

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