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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies
Xiangjun Xu1, Ke Yang1, Junfeng Xu1
1Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China.
Insights
Endovascular treatment for middle cerebral artery occlusion (MCAO) achieved similar recanalization and functional outcomes across different stroke subtypes. Further research is needed to optimize management strategies for MCAO patients with varied etiologies.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Surgery
Background:
- Acute ischemic stroke due to middle cerebral artery (MCA) M1 segment occlusion is a critical condition.
- Endovascular treatment (EVT) has become a standard therapy for acute ischemic stroke.
- Understanding the impact of different etiologies on EVT outcomes is crucial for personalized treatment.
Purpose of the Study:
- To compare endovascular treatment (EVT) outcomes in patients with M1 segment middle cerebral artery occlusion (MCAO) based on distinct pathologic subtypes.
- To identify potential differences in baseline characteristics, EVT factors, and clinical outcomes among these subtypes.
Main Methods:
- Retrospective analysis of 220 patients with MCAO who underwent EVT between July 2014 and December 2020.
- Categorization into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS), and embolism from tandem ICA steno-occlusion (MCAO-T).
- Comparison of baseline characteristics, EVT factors, and 90-day clinical outcomes, including functional independence and mortality, using multivariable regression analyses.
Main Results:
- MCAO-E was the most frequent etiology (58.6%), followed by MCAO-AS (21.4%) and MCAO-T (20.0%).
- Patients with MCAO-AS and MCAO-T required more rescue interventions, but recanalization rates were comparable across groups.
- The MCAO-AS group demonstrated better functional outcomes and lower mortality compared to the MCAO-E group, though stroke subtype was not an independent predictor in multivariable analysis.
Conclusions:
- Acute MCA M1 occlusion stroke patients treated with EVT exhibit similar successful recanalization rates and 90-day functional independence regardless of the underlying pathogenesis.
- Optimal management strategies for MCAO patients with diverse etiologies warrant further investigation.
Purpose:
The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes.
Methods:
Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90 days after stroke.
Results:
Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0-2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality.
Conclusions:
Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90 days. The optimal management for MCAO patients with different aetiologies requires further research.
