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Mechanical Thrombectomy for Middle Cerebral Artery Division Occlusions: A Systematic Review and Meta-Analysis
Hisham Salahuddin1, Aixa Espinosa1, Mark Buehler2
1Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA.
Background:
Middle cerebral artery division (M2) occlusion was significantly underrepresented in recent mechanical thrombectomy (MT) randomized controlled trials, and the approach to this disease remains heterogeneous.
Objective:
To conduct a systematic review and meta-analysis of outcomes at 90 days among patients undergoing MT for M2 middle cerebral artery (MCA) occlusions.
Methods:
Five clinical databases were searched from inception through September 2016. Observational studies reporting 90-day modified Rankin Scale scores for patients undergoing MT for M2 MCA occlusions with an M1 MCA control group were selected. The primary outcome of interest was good clinical outcome 90 days after MT of an M1 or M2 MCA occlusion. Secondary outcomes of interest included mortality and excellent clinical outcome, recanalization rates, significant intracerebral hemorrhage, and procedural complications.
Results:
A total of 323 publications were identified, and 237 potentially relevant articles were screened. Six studies were included in the analysis (M1 = 1,203, M2 = 258; total n = 1,461). We found no significant differences in good clinical outcomes (1.10 [95% CI, 0.83-1.44]), excellent clinical outcomes (1.07 [0.65-1.79]), mortality at 3 months (0.85 [0.58-1.24]), recanalization rates (1.06 [0.32-3.48]), and significant intracranial hemorrhage (1.19 [0.61-2.30]).
Conclusions:
MT of M2 MCA occlusions is as safe as that of main trunk MCA occlusions, and comparable in terms of clinical outcomes and hemorrhagic complications. Randomized clinical trials are needed to assess the impact of MT in patients with M2 occlusions, given that M1 MCA occlusions have different natural histories than M2 occlusions.
Insights
Mechanical thrombectomy (MT) for M2 middle cerebral artery (MCA) occlusions shows comparable safety and clinical outcomes to M1 MCA occlusions. Further randomized trials are needed to confirm these findings for M2 occlusions.
Area of Science:
- Neurology
- Interventional Neurology
- Vascular Neurology
Background:
- Mechanical thrombectomy (MT) for M2 middle cerebral artery (MCA) occlusions is underrepresented in recent trials.
- Treatment approaches for M2 MCA occlusions remain heterogeneous.
Purpose of the Study:
- To systematically review and meta-analyze 90-day outcomes for patients undergoing MT for M2 MCA occlusions.
- To compare outcomes of MT for M2 MCA occlusions with M1 MCA occlusions.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Searched five clinical databases up to September 2016.
- Included studies reporting 90-day modified Rankin Scale scores for M2 MCA occlusions with an M1 MCA control group.
Main Results:
- Six studies included 1,461 patients (M1=1,203, M2=258).
- No significant differences found in good clinical outcomes (1.10 [0.83-1.44]), excellent outcomes (1.07 [0.65-1.79]), mortality (0.85 [0.58-1.24]), recanalization (1.06 [0.32-3.48]), or hemorrhage (1.19 [0.61-2.30]).
Conclusions:
- MT of M2 MCA occlusions is as safe as MT of M1 MCA occlusions.
- Clinical outcomes and hemorrhagic complications are comparable between M1 and M2 MCA occlusions.
- Randomized clinical trials are necessary to evaluate MT impact in M2 occlusions due to differing natural histories.
