Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review

Chen, Ching-Jen; Wang, Connor; Buell, Thomas J.; Ding, Dale; Raper, Daniel; Ironside, Natasha; Paisan, Gabriella; Starke, Robert M.; Southerland, Andrew M; Liu, Kenneth; Worrall, Bradford B.

doi:10.1016/j.wneu.2017.08.108

Cited by 43 publications

(27 citation statements)

References 25 publications

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“…All these results are within the ranges of those reported for comparable-size arterial occlusions (i.e. distal occlusions) of the anterior circulation [18]. It is noteworthy that stroke aetiology was cardio-embolic in most cases in our study (68.2%).…”

Section: Discussionsupporting

confidence: 90%

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Clarençon

Baronnet

Shotar

et al. 2020

Euro J of Neurology

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Background and purpose: The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. Method: Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 AE 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. Results: Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. Conclusion: Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.Correspondence: F. Clarenc ßon,

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Section: Discussionsupporting

confidence: 90%

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Clarençon

Baronnet

Shotar

et al. 2020

Euro J of Neurology

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“…With the M2 segment being more distal, the volume of tissue at risk is conceptually smaller than an occlusion of a more proximal branch. As a result, there may be a reduced benefit or less significant improvement in functional status of EVT for M2 occlusions compared with M1 segment occlusions . However, small distal M2 occlusions involving the eloquent cortex may cause significant neurological impairment, and these patients may benefit from reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Findakly

Maingard

Phan

et al. 2020

Internal Medicine Journal

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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.

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“…6 In another metaanalysis, symptomatic intracranial hemorrhage was observed in 5% of patients. 10 In our study, the rate of symptomatic intracranial hemorrhage was 6.1%.…”

Section: Discussionmentioning

confidence: 43%

“…In the meta-analysis of M2 occlusions conducted by Chen et al, excellent and good outcomes at the three-month follow-up were observed in 40% and 62% of patients, respectively. 10 In the meta-analysis of Saber et al, functional independence (mRs 0-2) was observed in 59% of patients. 6 In the HERMES meta-analysis, 130 patients with M2 occlusion were analyzed, with modified TICI (mTICI) scores of 2b/3 in 59.2% of patients and better clinical outcome in patients treated with EVT compared with the control group (58.2% vs. 39.7% of patients, p ¼ 0.03).…”

Section: Discussionmentioning

confidence: 98%

Aspiration thrombectomy as the first-line treatment of M2 occlusions

et al. 2020

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Purpose The aim of the present study was (i) to evaluate the safety and efficacy of aspiration thrombectomy in patients with M2 occlusions and (ii) to compare outcome of treatment of occlusion of different M2 segments. Materials and methods Between March 2016 and June 2019, 82 patients with acute ischemic stroke and isolated M2 occlusions were treated in cerebrovascular stroke center with aspiration thrombectomy as the first-line treatment. Functional outcomes of patients with different types of M2 occlusions were statistically compared. Multivariable logistic regression analysis was performed to determine the factors associated with good clinical outcome. Results The mean age was 71.9 ± 13.4 years, 47.6% were men. Aspiration thrombectomy alone was utilized in 72.5% of patients, with 27.5% of patients being treated with a combination of aspiration thrombectomy and stent retriever. At the three-month follow-up, there was no statistically significant difference in functional outcome between different types of M2 occlusions (p = 0.662), however in the underpowered analysis because of the small sample size of patients, with good clinical outcome mRS 0–2 in 50% of all treated patients. Symptomatic intracranial hemorrhage was found in 6.1% of patients. Lower age (OR 0.932, 95% CI 0.878–0.988) and lower NIHSS score upon admission (OR 0.893, 95% CI 0.805–0.991) were independent predictors of good clinical outcome. Conclusion Aspiration thrombectomy appeared to be a safe and effective first-line treatment option for patients with M2 occlusion, being the first-line option for almost three-quarters of patients.

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Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review

Cited by 43 publications

References 25 publications

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

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

Aspiration thrombectomy as the first-line treatment of M2 occlusions

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