Endovascular clot retrieval for M2 segment middle cerebral artery occlusion: a systematic review and meta‐analysis

Abstract

Background: Endovascular clot retrieval (ECR) is the standard of care for acute ischaemic stroke due to large vessel occlusion. However, isolated occlusion of the M2 segment of the middle cerebral artery (MCA) was underrepresented in the landmark trials.Aims: Given the potential treatment benefit associated with M2 MCA occlusions, we aimed to evaluate the outcome of patients undergoing ECR for M2 occlusion. Methods:We conducted a systematic review and meta-analysis of the available literature that included patients with M2 MCA occlusions who underwent ECR. Successful reperfusion was defined as a treatment in cerebral ischaemia score of 2b-3. Good outcome was defined as a modified Rankin Scale score ≤ 2. We also analysed complications such as postprocedure symptomatic intracranial haemorrhage and mortality at 3 months.Results: Fifteen studies including 1105 patients with isolated M2 occlusions were analysed. Successful reperfusion occurred in 75.4% (95% confidence interval (CI) 67.7-84.1%) of patients; good outcome was observed in 58.3% (95% CI 51.7-63.8% of patients. The rate of symptomatic intracranial haemorrhage was 5.1% (95% CI 4.2-8.3%), and 3-month mortality rate was 12.2% (95% CI 10.4-16.3%). Conclusion:The outcomes of ECR treatment of M2 occlusions are favourable, with good safety profile. Comparison to medical management from large registries or randomised controlled trials is warranted.

Effect of Solitaire FR Stent Thrombectomy Combined with the Suction Thrombus on the Clinical Effect and Prognosis of Acute Middle Cerebral Artery Occlusion

“…Therefore, early diagnosis of AMCAO, opening of occluded blood vessels, avoiding irreversible damage to nerve cells, and preventing recurrence are the key measures for treatment [ 3 ]. Arterial and intravenous thrombolysis has been a commonly used method of vascular recanalization in the past, but its application is limited due to strict time window control, poor prognosis, and a high vascular reocclusion rate [ 4 ]. In recent years, stent mechanical thrombectomy, the suction thrombus, and stents combined with the suction thrombus have been used in the treatment of AMCAO.…”

The Feasibility Mechanism of Nerve Interventional Thrombectomy for Occlusion of Cranial Artery M1 and M2 Segments

“…The middle cerebral artery (MCA) is usually divided into five segments on the image: M1 (horizontal), M2 (circumflex), M3 (lateral sulcus), M4 (bifurcation), and M5 segment (angular gyrus artery) [ 1 , 2 ]. The MCA serves as the main blood vessel, and the ischemic stroke caused by the MCA occlusion is much higher than that caused by other blood vessel occlusion [ 3 , 4 ]. Stroke is a common ischemic encephalopathy; the clinical manifestations are mainly blindness, contralateral hemiplegia, sensory disturbance, hemianopia, etc., often accompanied by coma and poor prognosis [ 5 , 6 ].…”

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

“…2 Current American Heart Association and American Stroke Association guidelines state that endovascular treatment has class I level A (strong) evidence for acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but only class II level B (reasonable) evidence for distal occlusions. 3,4 Given the improvement in device technology and the increased familiarization of operators with distal occlusions, an improvement in the results of distal occlusion treatment is expected. Therefore, we report the outcomes of patients with acute M2 vessel occlusions after intra-arterial mechanical thrombectomy with second-generation devices.…”

“…Current American Heart Association and American Stroke Association guidelines state that endovascular treatment has class I level A (strong) evidence for acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but only class II level B (reasonable) evidence for distal occlusions. 3,4…”