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Mechanical thrombectomy of M1 and M2 middle cerebral artery occlusions
Hisham Salahuddin1, Guru Ramaiah1, Diana E Slawski1
1Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
Background:
Over half of patients who receive intravenous tissue plasminogen activator for middle cerebral artery division (MCA-M2) occlusion do not recanalize, leaving a large percentage of patients who may need mechanical thrombectomy (MT). However, the outcomes of MT for M2 occlusion have not been well characterized.
Objective:
To determine if MT of M2 occlusion is as safe and efficacious as current standard-of-care MT for M1 occlusions.
Methods:
With institutional review board approval, we retrospectively reviewed records of 212 patients undergoing MT for isolated MCA M1 or M2 occlusions during a 36-month period (Sept 2013 to Sept 2016) at two centres. Treatment variables, clinical outcomes, and complications in each group were recorded.
Results:
There were 153 M1 MCA occlusions and 59 M2 MCA occlusions. No statistically significant difference was found in the rate of mortality (20% in M1 vs 13.6% in M2, p=0.32), excellent (34.5% vs 37.3%, p=0.75) or good (51% vs 55.9%, p=0.54) clinical outcomes between the two groups. Infarct volumes (48.4 mL vs 46.2 mL, p=0.62) were comparable between the two groups, as were the rates of hemorrhagic (3.3% vs 3.4%, p=1.0) and procedural complications (3.3% vs 5.1%, p=0.69).
Conclusion:
Our data on MT targeting M2 occlusions demonstrates reasonable safety and functional outcomes. Further randomized clinical trials are needed to clarify which patients may benefit from MT for M2 occlusions.
Insights
Mechanical thrombectomy (MT) for middle cerebral artery (MCA) M2 occlusions shows comparable safety and functional outcomes to M1 occlusions. Further trials are needed to identify optimal candidates for MT in M2 occlusions.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Many patients with middle cerebral artery (MCA) M2 occlusions do not recanalize with intravenous thrombolysis.
- Mechanical thrombectomy (MT) is a potential treatment, but its outcomes for M2 occlusions are not well-established.
- Comparing MT for M2 occlusions to the standard of care for M1 occlusions is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of MT for M2 occlusions.
- To compare MT outcomes in M2 occlusions against M1 occlusions.
Main Methods:
- Retrospective review of 212 patients undergoing MT for isolated MCA M1 or M2 occlusions.
- Data collected included treatment variables, clinical outcomes, and complications.
- Analysis compared outcomes between M1 and M2 occlusion groups.
Main Results:
- No significant differences in mortality, excellent, or good clinical outcomes between M1 and M2 groups.
- Comparable infarct volumes between M1 and M2 occlusions.
- Similar rates of hemorrhagic and procedural complications for both groups.
Conclusions:
- MT for M2 occlusions demonstrates acceptable safety and functional outcomes.
- Further randomized trials are necessary to define patient selection for MT in M2 occlusions.
