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Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits
Tomas Dobrocky1, Eike I Piechowiak1, Bastian Volbers2,3
1Institute of Diagnostic and Interventional Neuroradiology (T.D., E.I.P., N.S., J.K., J.G., P.M.), Inselspital, University Hospital of Bern, Switzerland.
Background And Purpose:
Treatment in stroke patients with M2 segment occlusion of the middle cerebral artery presenting with mild neurological deficits is a matter of debate. The main purpose was to compare the outcome in patients with a minor stroke and a M2 occlusion.
Methods:
Consecutive intravenous thrombolysis (IVT) eligible patients admitted to the Bernese stroke center between January 2005 and January 2020 with acute occlusion of the M2 segment and National Institutes of Health Stroke Scale score ≤5 were included. Outcome was compared between IVT only versus endovascular therapy (EVT) including intra-arterial thrombolysis and mechanical thrombectomy (MT; ±IVT) and between IVT only versus MT only.
Results:
Among 169 patients (38.5% women, median age 70.2 years), 84 (49.7%) received IVT only and 85 (50.3%) EVT (±IVT), the latter including 39 (45.9%) treated with MT only. Groups were similar in sex, age, vascular risk factors, event cause, or preevent independency. Compared with IVT only, there was no difference in favorable outcome (modified Rankin Scale score, 0-2) for EVT (adjusted odds ratio, 0.96; adjusted P=0.935) or for MT only (adjusted odds ratio, 1.12; adjusted P=0.547) groups. Considering only patients treated after 2015, there was a significantly better 3-month modified Rankin Scale shift (adjusted P=0.032) in the EVT compared with the IVT only group.
Conclusions:
Our study demonstrates similar effectiveness of IVT only versus EVT (±IVT), and of IVT only versus MT only in patients with peripheral middle cerebral artery occlusions and minor neurological deficits and indicates a possible benefit of EVT considering only patients treated after 2015. There is an unmet need for randomized controlled trials in this stroke field, including imaging parameters, and more sophisticated evaluation of National Institutes of Health Stroke Scale score subitems, neurocognition, and quality of life neglected by the standard outcome scales such as modified Rankin Scale and National Institutes of Health Stroke Scale score.
Insights
For minor strokes due to M2 segment middle cerebral artery occlusion, intravenous thrombolysis (IVT) showed similar outcomes to endovascular therapy (EVT). However, EVT may offer benefits for patients treated more recently.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Medicine
Background:
- Treatment for mild neurological deficits from M2 segment middle cerebral artery occlusion is debated.
- Minor strokes with M2 occlusions require comparative outcome analysis.
Purpose of the Study:
- To compare outcomes between intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients with minor stroke and M2 occlusion.
- To evaluate IVT alone versus mechanical thrombectomy (MT) alone outcomes.
Main Methods:
- Included IVT-eligible patients with acute M2 segment occlusion and NIH Stroke Scale score ≤5.
- Compared outcomes for IVT only vs. EVT (including MT ± IVT).
- Compared IVT only vs. MT only.
Main Results:
- No significant difference in favorable outcomes (modified Rankin Scale 0-2) between IVT only and EVT or MT only groups.
- A trend towards better outcomes with EVT was observed in patients treated after 2015.
- Groups were comparable in demographics and risk factors.
Conclusions:
- IVT alone and EVT show similar effectiveness for minor strokes with M2 occlusions.
- EVT may offer a potential benefit in more recent treatment cohorts.
- Further randomized controlled trials are needed to evaluate advanced metrics beyond standard scales.
