Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience
Alan Flores1, Alejandro Tomasello2, Pere Cardona3
1Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Background:
Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment.
Objective:
To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers.
Methods:
We studied patients prospectively included in the SONIIA registry (years 2011-2012)-a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b-3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24-36 h; and good outcome as modified Rankin score (mRS) 0-2 at 3months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume.
Results:
Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289 ± 195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0-2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01).
Conclusions:
Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.
Insights
Endovascular treatment for M2 middle cerebral artery occlusions using stentrievers is safe and effective. Achieving good recanalization significantly improves patient outcomes, especially for those with moderate to severe neurological deficits.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Middle cerebral artery (MCA) M2 segment occlusions are a significant cause of ischemic stroke.
- Current treatment guidelines do not consistently recommend endovascular therapy for M2 occlusions.
- Stentrievers have emerged as a key technology in endovascular stroke treatment.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular treatment for M2 MCA occlusions.
- To assess outcomes in patients treated with stentrievers in the current era.
- To identify predictors of successful reperfusion and favorable clinical outcomes.
Main Methods:
- Prospective data collection from the SONIIA registry (2011-2012).
- Inclusion of patients with M2 MCA occlusions undergoing endovascular treatment.
- Definition of outcomes: good recanalization (TICI 2b-3), dramatic recovery (NIHSS drop >10 or <2), and good outcome (mRS 0-2 at 3 months).
- Assessment of symptomatic intracranial hemorrhage (SICH) and infarct volume via CT scan.
Main Results:
- Out of 571 endovascularly treated patients, 65 (11.4%) had M2 occlusions.
- Stentrievers were used in 86.2% of M2 occlusion cases.
- Good recanalization (78.5%) was strongly associated with dramatic improvement (48% vs. 14.8%), smaller infarct volumes (8 vs. 82 cc), and better 3-month outcomes (mRS 0-2: 66.3% vs. 30%).
- Good recanalization independently predicted dramatic improvement (OR=5.9).
- Age and baseline NIHSS were independent predictors of good 3-month outcome.
Conclusions:
- Endovascular treatment of M2 MCA occlusions with stentrievers is a safe therapeutic option.
- Successful recanalization significantly increases the likelihood of a favorable outcome.
- This approach is particularly beneficial for patients presenting with moderate to severe neurological deficits.
