Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results

Abstract

BackgroundThe predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice.MethodsPatients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0–2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram.ResultsA total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality.ConclusionsSuccessful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.

First-line thrombectomy strategy for distal and medium vessel occlusions: a systematic review

“…Six two-armed studies compared the performance of SR and ASP techniques 16–21. Four three-armed studies compared the performance of SR+ASP to ASP and SR 22–25. Three two-armed studies compared the safety and efficacy of SR+ASP with SR or ASP alone 26–28…”

“…Table 1 summarizes results and characteristics of the studies included within the qualitative review. All the included studies, except Muszynski et al , provided raw data for successful recanalization 23 25. All studies provided data for thrombus location.…”

“…Of the studies included for qualitative synthesis, two were considered to be low risk of bias, four were moderate risk of bias, four were serious risk of bias, and three were critical risk of bias (figure 2A). The highest quality studies were multicenter prospective studies performed by Gory et al (sub-analysis of the ASTER randomized trial: NCT02523261) and Muszynski et al (ETIS registry: NCT03776877), which provide more robust comparisons of clinical outcomes between the main interventions of interest 16 23. Of note, the retrospective studies performed by Baig et al 22 and Mokin et al 21 were primarily considered to be at a critical risk of bias because their study designs do not have a key focus on comparative analyses of the interventions summarized in this review.…”

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

“…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 ].…”

“…Similar results were also obtained by IAT in a subgroup analysis of PROACT-II (Prolyse in Acute Cerebral Thromboembolism II) [ 4 ], with good clinical outcome achieved in only 28.6% of patients after best medical management, but in 48.6% of patients after MT. The impact of successful reperfusion has been shown in the ETIS Registry (excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p = 0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p = 0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p < 0.01) [ 24 ], while Boyanpally et al found no additional benefit of MT compared to best medical management of M2 lesions [ 35 ].…”