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Comparison of Superior and Inferior Division Occlusions Treated with Endovascular Thrombectomy

Fatih Seker1, Johannes Pfaff1, Ulf Neuberger1

  • 1Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.

Clinical Neuroradiology
|February 22, 2019
PubMed

Insights

Thrombectomy for M2 segment middle cerebral artery occlusions shows inferior division occlusions have better outcomes. Superior division occlusions independently predict poorer outcomes despite similar recanalization rates.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Cerebrovascular Diseases

Background:

  • Mechanical thrombectomy is a recognized treatment for M2 segment middle cerebral artery (MCA) occlusions.
  • The MCA M2 segment is divided into superior and inferior divisions, with potential differences in treatment outcomes.
  • Previous studies have established the safety and efficacy of thrombectomy for M2 occlusions.

Purpose of the Study:

  • To compare radiological and clinical outcomes between superior and inferior division M2 MCA occlusions treated with thrombectomy.
  • To identify predictors of good and poor outcomes in patients undergoing thrombectomy for M2 MCA occlusions.

Main Methods:

  • Retrospective analysis of 140 patients treated with thrombectomy for superior (n=87) or inferior (n=53) M2 MCA occlusions between 2009 and 2017.
  • Univariate and multivariate analyses were conducted to compare outcomes and identify predictors.
  • Key outcome measures included good clinical outcome (defined by functional independence), recanalization rates, complication rates, and infarct size.

Main Results:

  • Inferior division occlusions had a significantly higher rate of good outcome (66.0%) compared to superior division occlusions (48.3%, P=0.041).
  • Time from groin puncture to reperfusion, recanalization success, complication rate, hemorrhage rate, and follow-up infarct size were similar between the groups.
  • Independent predictors of good outcome included higher baseline Alberta Stroke Program Early CT Score (ASPECTS), shorter time from groin puncture to reperfusion, and Thrombolysis In Cerebral Infarction (TICI) scores of 2b-3.
  • Superior division occlusion was identified as an independent predictor of poor outcome (OR 2.41, P=0.042).

Conclusions:

  • Patients with superior division M2 MCA occlusions have a lower likelihood of achieving a good clinical outcome compared to those with inferior division occlusions.
  • Recanalization rates and complication profiles are comparable between superior and inferior M2 MCA occlusions.
  • Baseline ASPECTS, reperfusion time, and TICI scores are crucial predictors of successful thrombectomy outcomes.
Abstract

Keywords:
BranchDistalM2OutcomePeripheralStroke

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