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Updated: Jul 12, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Predictors of functional outcome after thrombectomy for M2 occlusions: a large scale experience from clinical
Helge Kniep1, Lukas Meyer2, Gabriel Broocks2
1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. h.kniep@uke.de.
Abstract:
Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions is still a matter of debate. We sought to identify factors associated with clinical outcome after MT for M2-occlusions based on data from the German Stroke Registry-Endovascular Treatment (GSR-ET). All patients prospectively enrolled in the GSR-ET from 05/2015 to 12/2021 were analyzed (NCT03356392). Inclusion criteria were primary M2-occlusions and availability of relevant clinical data. Factors associated with excellent/good outcome (modified Rankin scale mRS 0-1/0-2), poor outcome/death (mRS 5-6) and mRS-increase pre-stroke to day 90 were determined in multivariable logistic regression. 1348 patients were included. 1128(84%) had successful recanalization, 595(44%) achieved good outcome, 402 (30%) had poor outcome. Successful recanalization (odds ratio [OR] 4.27 [95% confidence interval 3.12-5.91], p < 0.001), higher Alberta stroke program early CT score (OR 1.25 [1.18-1.32], p < 0.001) and i.v. thrombolysis (OR 1.28 [1.07-1.54], p < 0.01) increased probability of good outcome, while age (OR 0.95 [0.94-0.95], p < 0.001), higher pre-stroke-mRS (OR 0.36 [0.31-0.40], p < 0.001), higher baseline NIHSS (OR 0.89 [0.88-0.91], p < 0.001), diabetes (OR 0.52 [0.42-0.64], p < 0.001), higher number of passes (OR 0.75 [0.70-0.80], p < 0.001) and intracranial hemorrhage (OR 0.26 [0.14-0.46], p < 0.001) decreased the probability of good outcome. Additional predictors of mRS-increase pre-stroke to 90d were dissections, perforations (OR 1.59 [1.11-2.29], p < 0.05) and clot migration, embolization (OR 1.67 [1.21-2.30], p < 0.01). Corresponding to large-vessel-occlusions, younger age, low pre-stroke-mRS, low severity of acute clinical disability, i.v. thrombolysis and successful recanalization were associated with good outcome while diabetes and higher number of passes decreased probability of good outcome after MT in M2 occlusions. Treatment related complications increased probability of mRS increase pre-stroke to 90d.
Insights
Mechanical thrombectomy for medium vessel occlusions improves outcomes when recanalization is successful. Factors like younger age, lower baseline severity, and IV thrombolysis predict good results, while diabetes and more passes are associated with poorer outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) involving medium vessel occlusions (M2 occlusions) remains a subject of ongoing clinical debate.
- Identifying predictors of successful treatment outcomes is crucial for optimizing patient care and resource allocation in stroke management.
Purpose of the Study:
- To identify factors associated with favorable clinical outcomes (modified Rankin Scale [mRS] 0-2) after MT for M2 occlusions.
- To determine predictors of poor outcomes (mRS 5-6) and functional decline (mRS increase) from pre-stroke to 90 days post-MT.
Main Methods:
- Analysis of prospectively enrolled patients with primary M2 occlusions from the German Stroke Registry-Endovascular Treatment (GSR-ET) between May 2015 and December 2021.
- Multivariable logistic regression models were used to identify factors associated with good outcome, poor outcome, and mRS increase.
- Inclusion criteria: primary M2 occlusions and availability of relevant clinical data; NCT03356392.
Main Results:
- Of 1348 included patients, 84% achieved successful recanalization, 44% had a good outcome, and 30% experienced a poor outcome.
- Factors predicting good outcome included successful recanalization (OR 4.27), higher ASPECTS (OR 1.25), and IV thrombolysis (OR 1.28).
- Factors associated with decreased probability of good outcome were older age (OR 0.95), higher pre-stroke mRS (OR 0.36), higher NIHSS (OR 0.89), diabetes (OR 0.52), more passes (OR 0.75), and intracranial hemorrhage (OR 0.26).
- Dissections, perforations, and clot migration/embolization predicted increased mRS.
Conclusions:
- Successful recanalization, younger age, lower baseline disability, IV thrombolysis, and higher ASPECTS are associated with good outcomes in MT for M2 occlusions.
- Diabetes and a higher number of thrombectomy passes are linked to poorer outcomes.
- Treatment-related complications increase the likelihood of functional decline.
