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Published on: January 18, 2018
Aspiration thrombectomy as the first-line treatment of M2 occlusions
Jan Harsany1, Jozef Haring2, Matus Hoferica1
1Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia.
Purpose:
The aim of the present study was (i) to evaluate the safety and efficacy of aspiration thrombectomy in patients with M2 occlusions and (ii) to compare outcome of treatment of occlusion of different M2 segments.
Materials And Methods:
Between March 2016 and June 2019, 82 patients with acute ischemic stroke and isolated M2 occlusions were treated in cerebrovascular stroke center with aspiration thrombectomy as the first-line treatment. Functional outcomes of patients with different types of M2 occlusions were statistically compared. Multivariable logistic regression analysis was performed to determine the factors associated with good clinical outcome.
Results:
The mean age was 71.9 ± 13.4 years, 47.6% were men. Aspiration thrombectomy alone was utilized in 72.5% of patients, with 27.5% of patients being treated with a combination of aspiration thrombectomy and stent retriever. At the three-month follow-up, there was no statistically significant difference in functional outcome between different types of M2 occlusions (p = 0.662), however in the underpowered analysis because of the small sample size of patients, with good clinical outcome mRS 0-2 in 50% of all treated patients. Symptomatic intracranial hemorrhage was found in 6.1% of patients. Lower age (OR 0.932, 95% CI 0.878-0.988) and lower NIHSS score upon admission (OR 0.893, 95% CI 0.805-0.991) were independent predictors of good clinical outcome.
Conclusion:
Aspiration thrombectomy appeared to be a safe and effective first-line treatment option for patients with M2 occlusion, being the first-line option for almost three-quarters of patients.
Insights
Aspiration thrombectomy is a safe and effective treatment for acute ischemic stroke due to M2 occlusions. This study found no significant difference in outcomes between different M2 segment occlusions.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Acute ischemic stroke poses a significant health burden.
- Occlusions in the M2 segment of the middle cerebral artery present unique treatment challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of aspiration thrombectomy for M2 occlusions.
- To compare outcomes across different M2 segment occlusion types.
Main Methods:
- Retrospective analysis of 82 patients with acute ischemic stroke and M2 occlusions treated with aspiration thrombectomy.
- Comparison of functional outcomes based on M2 occlusion location.
- Multivariable logistic regression to identify predictors of good clinical outcome.
Main Results:
- Aspiration thrombectomy was used as first-line treatment in 72.5% of patients.
- No statistically significant difference in functional outcomes was observed between different M2 occlusion types.
- 50% of patients achieved a good clinical outcome (mRS 0-2) at three months.
- Symptomatic intracranial hemorrhage occurred in 6.1% of patients.
- Younger age and lower NIHSS scores predicted better outcomes.
Conclusions:
- Aspiration thrombectomy is a safe and effective first-line treatment for M2 occlusions.
- It offers a viable therapeutic option for a significant proportion of stroke patients.
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