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Differences between proximal and distal M1 occlusions after mechanical thrombectomy.

Seung Hwan Kim1, Seong Won Kim2, Hyungon Lee3

  • 1Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|April 17, 2021
PubMed
Summary

Proximal M1 and distal M1 occlusions showed similar clinical outcomes after mechanical thrombectomy. However, proximal M1 occlusions were linked to atherosclerosis and required more rescue treatments.

Keywords:
Acute ischemic strokeLenticulostriate perforatorsMechanical thrombectomyMiddle cerebral artery

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Neurology

Background:

  • Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke.
  • Understanding the impact of occlusion location within the M1 segment is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To compare clinical outcomes and baseline characteristics between proximal M1 (pM1) and distal M1 (dM1) occlusions treated with MT.
  • To investigate the etiological differences and procedural requirements for pM1 versus dM1 occlusions.

Main Methods:

  • Retrospective analysis of 141 patients undergoing MT for M1 occlusions from March 2010 to May 2019.
  • Categorization into pM1 (n=58) and dM1 (n=83) groups.
  • Comparison of clinical outcomes (modified Rankin Scale), occlusion etiology, and need for rescue treatments.

Main Results:

  • No significant difference in good clinical outcomes (mRS 0-2) between pM1 (48.3%) and dM1 (55.4%) occlusions (p=0.493).
  • pM1 occlusions were more frequently atherosclerotic (63.8%) compared to dM1 (32.5%) (p=0.001).
  • dM1 occlusions were more frequently cardioembolic (63.9%) compared to pM1 (32.6%) (p=0.001).
  • Rescue treatments were significantly more common in pM1 occlusions (36.2%) than dM1 occlusions (9.8%) (p<0.001).
  • pM1 occlusions were independently associated with the need for rescue treatment (aOR=3.804).

Conclusions:

  • Proximal and distal M1 occlusions do not significantly impact good clinical outcomes post-mechanical thrombectomy.
  • Etiology differs, with pM1 occlusions more associated with atherosclerosis and dM1 with cardioembolism.
  • Proximal M1 occlusions necessitate more frequent rescue interventions during mechanical thrombectomy.