MeVO: the next frontier?

Goyal, Mayank; Ospel, Johanna M.; Menon, Bijoy K; Hill, Michael D.

doi:10.1136/neurintsurg-2020-015807

Cited by 100 publications

(79 citation statements)

References 13 publications

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“…Given the variability in anatomy and clinical symptoms, a multidimensional definition based on morphological features (ie, vessel anatomy and size) and clinical deficits (ie, symptoms that are commensurate with the occluded vessel) may be preferred over a purely anatomical definition. 7…”

Section: Definition Of Medium-vessel Occlusionsmentioning

confidence: 99%

“…More than 50% of physicians would perform EVT in M3, A2,and P2 occlusions if the patient is ineligible for intravenous thrombolysis, but when intravenous thrombolytics can be safely administered, the willingness to proceed with EVT is substantially lower. 7 For now, until randomized trial data become available, the decision to treat or not to treat a MeVO will remain a subjective one that is influenced by many factors, including patient preferences, eligibility for intravenous thrombolysis, and operator skills. Treatment decision-making is further complicated by the variety of clinical symptoms MeVO patients can present with, which are dependent on the eloquence of the affected area.…”

Section: Clinical Evt Selection Criteria For Mevo Evtmentioning

confidence: 99%

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A review of endovascular treatment for medium vessel occlusion stroke

Ospel

Goyal

2021

J NeuroIntervent Surg

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Medium-vessel occlusions (MeVOs), that is, occlusions of the M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery segments, account for 25%–40% of all acute ischemic stroke cases. Clinical outcomes of MeVO stroke with intravenous thrombolysis, which is the current standard of care, are moderate at best. With improving imaging technologies and a growing literature, MeVOs are increasingly recognized as a target for endovascular treatment (EVT). For the time being, there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke, despite the lack of clear guideline recommendations. In this article, we review the evidence on endovascular treatment for MeVO stroke and summarize the available literature on current imaging strategies, commonly used EVT selection criteria, EVT techniques, and outcome assessment for MeVO stroke.

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Section: Definition Of Medium-vessel Occlusionsmentioning

confidence: 99%

Section: Clinical Evt Selection Criteria For Mevo Evtmentioning

confidence: 99%

A review of endovascular treatment for medium vessel occlusion stroke

Ospel

Goyal

2021

J NeuroIntervent Surg

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“…M2 occlusions in which the occluded MCA bifurcated after the horizontal segment were considered proximal occlusions. Proximal M2 was defined as the horizontal M2 segment from the main MCA bifurcation/trifurcation within 1 cm from the MCA bifurcation and distal M2 as the Sylvian M2 segment, starting 1 cm from the bifurcation/trifurcation to the circular sulcus of the insula (19)(20)(21). M2 caliber dominance was considered present if the M2 branch had a larger diameter than the other branches on digital subtraction angiography or if the perfusion defect associated with the occluded M2 branch was larger than 50% of the MCA territory.…”

Section: M2 Definitionmentioning

confidence: 99%

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

et al. 2021

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Introduction: The usefulness of the blind exchange with mini-pinning (BEMP) technique has recently been reported for mechanical thrombectomy in patients with stroke owing to medium vessel occlusion (MeVO). The Tron stent retriever can be delivered and deployed through a 0.0165-inch microcatheter. This retriever has potential as an effective and safe treatment for acute ischemic stroke (AIS) due to occlusion of the M2 segment of the middle cerebral artery (MCA). Here, we report the outcomes of the BEMP technique using Tron stent retrievers for M2 occlusion thrombectomy.Methods: Consecutive patients with AIS owing to M2 occlusion who underwent the BEMP technique using 2 × 15-mm or 4 × 20-mm Tron stent retrievers were included. The technique involves deploying a Tron stent retriever through a 0.0165-inch microcatheter, followed by microcatheter removal and blind navigation of a 3MAX or 4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot. A Tron stent retriever is inserted into the aspiration catheter like a cork and subsequently pulled as a unit. We assessed procedural outcomes [first-pass expanded thrombolysis in cerebral infarction (eTICI) score 2c/3 and 2b/2c/3], safety outcomes [symptomatic intracranial hemorrhage (sICH)], and clinical outcomes (good outcome rate defined as modified Rankin Scale score 0–2 at 90 days and mortality at 90 days).Results: Eighteen M2 vessels were treated in 15 patients (six female, median age: 80 years, and median National Institutes of Health Stroke Scale score: 18). The BEMP technique was performed successfully in all cases. Whether to use a 3MAX or 4MAX catheter was determined by considering one of the following target vessels: dominant, non-dominant, or co-dominant M2 (3MAX, n = 9; 4MAX, n = 9). The first-pass eTICI 2c/3 and 2b/2c/3 rates were 47 (7/15) and 60% (9/15), respectively; sICH was not observed. Seven patients (47%) achieved good outcomes, and one patient (7%) died within 90 days.Conclusions: The Tron stent retriever was safely and effectively used in the BEMP technique for acute MCA M2 occlusion and can be combined with a 0.0165-inch microcatheter, which may be useful for treating MeVO, in general.

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“…Although the benefit of MT in MeVOs is suggested in several non-controlled observational studies (mainly in patients with M2 occlusions), these findings need to be confirmed in RCTs. 41 MeVOs (M2 or M3 segments of the MCA, pericallosal artery or the posterior cerebral artery) can lead to severe AIS. While these smaller vessels can still cause a severe deficit, thrombectomies in these vascular beds raise some questions.…”

Section: Challenges and Future Prospectsmentioning

confidence: 99%

Direct aspiration stroke thrombectomy: a comprehensive review

Boisseau

Escalard

Fahed³

et al. 2020

J NeuroIntervent Surg

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Mechanical thrombectomy is now the standard of care for acute ischemic stroke patients with large vessel occlusions, and can be performed with several devices and techniques. One of these techniques, direct aspiration (DA), consists of navigating a large-bore catheter up to the face of the clot and initiating forceful suction. This comprehensive review has three objectives: (1) to describe the direct aspiration technique; (2) to present the available evidence regarding predictive factors of DA success and performance compared with other techniques; and (3) to discuss the forthcoming improvements in distal aspiration.

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MeVO: the next frontier?

Cited by 100 publications

References 13 publications

A review of endovascular treatment for medium vessel occlusion stroke

A review of endovascular treatment for medium vessel occlusion stroke

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

Direct aspiration stroke thrombectomy: a comprehensive review

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