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Updated: Jan 25, 2026
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Technical and Clinical Outcomes After Thrombectomy for the Various Segments of the Middle Cerebral Artery
Ali Alawieh1, Ryan T Kellogg2, A Rano Chatterjee3
1Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Background:
After showing the success of mechanical thrombectomy (MT) in treating large-vessel occlusion stroke, the target population has been expanded to include patients with smaller and more distal vessels including the M2 segment of the middle cerebral artery. We compared the procedural and clinical outcomes of patients undergoing MT using direct aspiration (ADAPT [A Direct Aspiration at first Pass Technique]) between superior or inferior divisions of M2 and M1.
Methods:
We retrospectively reviewed a database of patients undergoing MT between June 2013 and July 2018 at our center for clinical and procedural variables. Patients with isolated M1 or M2 occlusions were included. M2 occlusions were classified into superior and inferior divisions. Functional outcomes were collected at 90 days.
Results:
A total of 205 patients with M1, 65 with M2 superior division (middle cerebral artery M2 superior segment [M2S]), and 57 with inferior division (middle cerebral artery M2 inferior segment [M2I]) stroke were included. M1 and M2S patients had comparable National Institutes of Health Stroke Scale score at presentation, but higher than M2I (P < 0.01). Compared with M1, M2 occlusions had longer procedure times and required more aspiration attempts (P < 0.05). M2S thrombectomy had a significantly lower rate of successful recanalization (P < 0.05). Rates of good outcome (modified Rankin Scale score 0-2) were 46% in M1, 34% in M2S, and 44% in M2I, and postprocedural hemorrhage rates were comparable between groups. On multivariate analysis, M2S occlusion was associated with longer procedure times, lower odds of good outcomes, and lower TICI recanalization scores (P < 0.05) compared with M1.
Conclusions:
ADAPT is safe and effective in M2 stroke. The procedural success and efficacy of ADAPT in M2 stroke are influenced by the anatomic division with less favorable clinical and technical outcomes in the M2S division.
Insights
Direct aspiration first pass technique (ADAPT) is effective for M2 strokes. However, outcomes vary by M2 division, with the superior M2 segment showing less favorable results compared to the inferior division and M1.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Mechanical thrombectomy (MT) success has expanded its use to smaller vessels like the M2 segment of the middle cerebral artery.
- Direct aspiration first pass technique (ADAPT) is a key MT method for these distal occlusions.
Purpose of the Study:
- To compare procedural and clinical outcomes of ADAPT for M1 occlusions versus superior (M2S) and inferior (M2I) M2 segment occlusions.
- To evaluate the impact of M2 segment's specific anatomical division on ADAPT efficacy.
Main Methods:
- Retrospective review of 205 M1, 65 M2S, and 57 M2I stroke patients undergoing MT between June 2013 and July 2018.
- Analysis of clinical and procedural variables, including procedure time, aspiration attempts, recanalization rates, and 90-day functional outcomes (modified Rankin Scale).
Main Results:
- M2 occlusions, particularly M2S, required longer procedure times and more aspiration attempts than M1 occlusions.
- M2S thrombectomy showed significantly lower successful recanalization rates and odds of good outcomes compared to M1.
- Postprocedural hemorrhage rates were comparable across all groups (M1, M2S, M2I).
Conclusions:
- ADAPT is a safe and effective treatment for M2 segment strokes.
- The anatomical division of the M2 segment influences ADAPT's procedural success and clinical efficacy, with M2S demonstrating less favorable outcomes.
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