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Published on: January 23, 2019
Mechanical thrombectomy for middle cerebral artery M2 occlusions
Leyla Ramazanoglu1, Kalyoncu Isil Aslan1, Yilmaz Onal2
1Department of Neurology, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
Background:
The safety and efficacy of mechanical thrombectomy (MT) for proximal large vessel occlusion after acute ischemic stroke (AIS) have been demonstrated. Clinical investigations of endovascular approaches for treating AIS due to M2 occlusions have been ongoing.
Purpose:
To assess the outcomes of M2 occlusions according to treatment modality and anatomical division.
Methods:
A total of 113 consecutive M2 occlusions treated with endovascular treatment (EVT) at our tertiary stroke center between January 2019 and December 2022 were retrospectively analyzed. Patients were divided into three groups: mechanical thrombectomy (MT); intravenous thrombolysis plus MT (IVT + MT); and IVT alone. The primary outcomes were good prognosis (mRS = 0-2) and mortality (mRS = 6) on day 90. The secondary outcome was to determine the differences in outcomes between lesions in the superior and inferior branches of M2.
Results:
In total, 55 (48.7%) patients underwent MT. In 42 (37.2%) patients, bridging IVT was performed with MT, and IVT alone was applied in 16 (14.2%) patients. Neither the prognosis at 90 days nor the mortality rate significantly differed among the groups. The outcomes did not significantly differ between occlusions in the superior and inferior branches of M2.
Conclusion:
MT was found to be safe and effective for treating M2 occlusions in this series.
Insights
Mechanical thrombectomy (MT) is safe and effective for acute ischemic stroke (AIS) M2 occlusions. Treatment modality and anatomical location did not significantly impact 90-day prognosis or mortality in this study.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) is established for proximal large vessel occlusion in acute ischemic stroke (AIS).
- Endovascular treatment (EVT) for M2 occlusions in AIS is under active clinical investigation.
Purpose of the Study:
- To evaluate outcomes of M2 occlusions based on treatment strategy.
- To compare results between superior and inferior M2 branch occlusions.
Main Methods:
- Retrospective analysis of 113 consecutive M2 occlusions treated with EVT.
- Patients categorized into: MT alone, intravenous thrombolysis plus MT (IVT+MT), and IVT alone.
- Primary outcomes: 90-day functional prognosis (mRS 0-2) and mortality (mRS 6).
Main Results:
- Mechanical thrombectomy (MT) was used in 48.7% of cases.
- Bridging IVT with MT occurred in 37.2%, and IVT alone in 14.2%.
- No significant differences in 90-day prognosis or mortality were observed across treatment groups or between M2 superior/inferior branches.
Conclusions:
- Mechanical thrombectomy (MT) demonstrates safety and efficacy for M2 occlusions.
- Treatment modality and anatomical location did not significantly affect outcomes in this cohort.
