Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery

Nakano, Tomoyuki; Shigeta, Keigo; Ota, Terukazu; Amano, Takahiro; Ueda, Masayuki; Matsumaru, Yuji; Shiokawa, Yoshiaki; Hirano, Teruyuki

doi:10.1007/s00062-019-00810-3

Cited by 12 publications

(9 citation statements)

References 15 publications

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“…Unlike other authors, 19 we did not find significant differences in the time needed for recanalization. This could be explained by the improvement of the devices used, as well as by the training received by our team.…”

Section: Discussioncontrasting

confidence: 85%

Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery

et al. 2022

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Introduction Mechanical thrombectomy for large vessel occlusion in the anterior circulation has been shown to be beneficial. The question of whether this technique is safe and effective in the distal vasculature remains unanswered. We wanted to compare outcome data from mechanical thrombectomy of M2 branches of the middle cerebral artery (MCA) with those of the M1 segment, and better understand the clinical predictors of these M2 occlusions. Methods A retrospective analysis was performed of data prospectively collected between January 2017 and July 2021 from patients with acute ischemic stroke undergoing mechanical thrombectomy of isolated M1 or M2 branches of the MCA. Results 350 patients were identified, 287 with M1 and 63 with M2 occlusions. Mean age was 70.71 ± 12.55 and 75.21 ± 10.21 years, respectively (p = 0.0083). Baseline Alberta Stroke Program Computed Tomography (ASPECT) score was worse in the M1 cohort (7.68 ± 1.73 vs. 8.32 ± 1.54; p = 0.0079), while there was no significant difference in National Institutes of Health Stroke Scale (NIHSS) scores. No statistical disparity existed in mean procedure duration for each cohort; fewer thrombectomy attempts were required in the M2 cohort (2.01 vs. 1.63; p = 0.0478). There was no statistical difference in total time to recanalization (559.19 vs. 629.97, p = 0.2506). Similar rates of successful reperfusion were observed (Thrombolysis in Ischaemic Stroke score [TICI] ≥ 2b 80.84% vs. 71.43% p = 0.1221). Good outcome (modified Rankin scale ≤ 2) was 56.10 in M1 occlusions and 63.49% on M2 groups. Intracranial haemorrhage rates were similar. Conclusions M2 thrombectomy is safe and a significant proportion of patients achieve a good clinical outcome. Advanced age, atrial fibrillation and previous treatment with anticoagulants were predictors for poor outcome. Good outcome was achieved when effective recanalization was obtained.

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Section: Discussioncontrasting

confidence: 85%

Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery

et al. 2022

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“…Our results are also in this range (83%), comparable to those of a recent meta-analysis (81%) [ 23 ], and higher than in the Hermes registry (71%) [ 6 ]. As far as the available literature shows, the chance for successful recanalization is equal or even higher for M2 than for M1 occlusions [ 9 , 14 , 24 , 25 ]. Compared to the STRATIS-Registry, the overall results for good clinical outcome and mortality within the GSR are less favorable, especially when considering M1 occlusions [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)

Herzberg

Dorn

Trumm

et al. 2022

JCM

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There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0–2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65–82) and 77 (CI 66–83) years, respectively. Except for baseline NIHSS (15 (CI 10–18) vs. 11 (CI 6–16), p < 0.001) and ASPECTS (9 (CI 7–10) vs. 9 (CI 8–10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7–42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2–8) vs. 2 (CI 2–7)/(CI 2–2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome.

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“…The clinical benefit of MT for M2 occlusion has been long controversial. 19) Given the limited evidence regarding the outcomes or safety of isolated M2 occlusions, well-defined recommendations are currently unavailable. Based on five recent randomized trials, MT is currently recommended as the standard treatment for patients with ELVO.…”

Section: Evidence Regarding Mechanical Thrombectomy For Isolated M2 Segment Occlusionsmentioning

confidence: 99%

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: A literature review

Cho

Choi

2021

J Cerebrovasc Endovasc Neurosurg

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Thanks to new generation devices, mechanical thrombectomy (MT) has substantially evolved and become the standard treatment for patients with acute occlusion of the internal carotid artery or proximal middle cerebral artery (MCA) (M1 segment). However, the role and benefit of MT in patients with distal MCA (M2 segment) occlusion remain unclear. Therefore, there is a need for further studies. To evaluate the efficacy and safety of MT for M2 occlusion, this article reviews the natural course of M2 occlusion, the evidence regarding MT for M2 segment occlusion, clinical outcomes of MT for M2 occlusion, and treatment outcomes according to device type.

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Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery

Cited by 12 publications

References 15 publications

Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery

Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery

Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: A literature review

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