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Published on: October 20, 2017
Endovascular Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery: A Safe and Effective
Adrien Marchal1, Martin Bretzner2, Barbara Casolla3
1Department of Interventional Neuroradiology, CHU Lille, Lille, France.
Background:
Distal medium vessel occlusions (DMVOs) are increasingly recognized as a next target for endovascular thrombectomy (EVT). Our objective was to investigate safety and clinical outcomes of EVT for DMVO of the middle cerebral artery (MCA).
Methods:
We analyzed data of the Lille Reperfusion Registry from January 2017 to September 2020. Patients with a primary or secondary DMVO of the MCA seen on pretreatment angiogram were included. Only patients with a eTICI score 2b50-2b67 on initial angiogram were considered. Baseline characteristics, angiographic clinical, and safety outcomes were compared between patients treated with EVT or standard medical treatment (no-EVT).
Results:
Of the 171 patients included, 96 received EVT (46.9% male, 68.7 ± 15.8 years) and 75 received standard medical treatment (44% male, 73.9 ± 13.1 years). EVT patients had a better improvement of the NIHSS score at discharge (adjusted mean difference: 3.71; 95% CI: 1.18-6.24). In the distal M2 occlusions subgroup, EVT was significantly associated with a higher rate of early neurologic improvement (adjusted OR: 3.62 95% CI: 1.31-10.03), NIHSS improvement at discharge (adjusted mean difference: 5.23; 95% CI: 2.18-8.29), and improved modified Rankin Scale score at 3 months (adjusted common OR for 1 point improvement: 3.06; 95% CI: 1.30 to 7.23). Symptomatic intracranial hemorrhage occurred in 3.1% in the EVT group and in 9.5% in the no-EVT group.
Conclusions:
EVT for DMVO of the MCA appears to be safe and may lead to improved clinical outcomes. This effect was especially pronounced in patients with distal M2 occlusions, warranting randomized trials to validate this result.
Insights
Endovascular thrombectomy (EVT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is safe and improves outcomes, particularly for distal M2 occlusions. Further trials are recommended.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Distal medium vessel occlusions (DMVOs) are an emerging target for endovascular thrombectomy (EVT).
- Middle cerebral artery (MCA) occlusions represent a significant proportion of stroke cases.
Purpose of the Study:
- To investigate the safety and clinical outcomes of EVT for DMVO of the MCA.
- To compare EVT with standard medical treatment for MCA DMVOs.
Main Methods:
- Analysis of the Lille Reperfusion Registry (January 2017-September 2020).
- Inclusion of patients with primary or secondary DMVO of the MCA and an initial eTICI score of 2b50-2b67.
- Comparison of baseline characteristics, angiographic, clinical, and safety outcomes between EVT and no-EVT groups.
Main Results:
- EVT patients showed better NIHSS score improvement at discharge (adjusted mean difference: 3.71).
- In distal M2 occlusions, EVT was associated with higher rates of early neurologic improvement, NIHSS improvement, and better 3-month mRS scores.
- Symptomatic intracranial hemorrhage rates were 3.1% for EVT and 9.5% for no-EVT.
Conclusions:
- EVT for DMVO of the MCA is safe and associated with improved clinical outcomes.
- The benefits of EVT are particularly pronounced in patients with distal M2 occlusions.
- Randomized trials are warranted to validate these findings.
