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Mechanical Thrombectomy in Medium Vessels Occlusion (MeVOs): An Institutional Experience with M2 Divisions of Middle
Bheru Dan Charan1, Shailesh B Gaikwad1, Savyasachi Jain1
1Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
Background:
Mechanical thrombectomy has been established as a safe, standard and effective treatment option for occlusions of the proximal segment of the middle cerebral artery (MCA), as demonstrated in numerous studies. However, performing thrombectomy in the M2 divisions of MCA presents inherent challenges. In this institutional experience, we aim to delineate the recanalisation rates achieved through mechanical thrombectomy in cases involving the M2 segment of the MCA.
Methods:
We conducted a retrospective analysis of patients who underwent thrombectomy due to M2 MCA occlusions in the period from January 2018 to December 2021. Various factors affecting recanalisation rates were assessed.
Results:
A total of 15 patients with M2 segment occlusions of the middle cerebral artery were included in the study, comprising 11 in the superior division and 4 in the inferior division. The successful recanalisation rate was 72.33%, with notably higher success observed in cases of inferior division occlusion. The primary outcome of our study was the mTICI recanalisation status, categorised as successful recanalisation (mTICI = 2b or mTICI = 3) and unsuccessful recanalisation (mTICI = 1 or mTICI = 2a) and mRS at 6 months. None of the predictors assessed reached statistical significance.
Conclusions:
Mechanical thrombectomy demonstrates favourable efficacy and recanalisation rates in cases of M2 MCA division occlusion. Notably, inferior division occlusions exhibit a higher likelihood of successful recanalisation.
Insights
Mechanical thrombectomy is effective for M2 middle cerebral artery (MCA) occlusions, achieving a 72.33% recanalisation rate. Inferior M2 division occlusions showed higher success rates in this study.
Area of Science:
- Neurology
- Interventional Neurology
- Vascular Neurology
Background:
- Mechanical thrombectomy is a standard treatment for proximal middle cerebral artery (MCA) occlusions.
- Challenges exist when performing thrombectomy in the M2 divisions of the MCA.
Purpose of the Study:
- To evaluate the recanalisation rates of mechanical thrombectomy in M2 segment MCA occlusions.
- To identify factors influencing recanalisation in M2 MCA occlusions.
Main Methods:
- Retrospective analysis of 15 patients with M2 MCA occlusions (January 2018 - December 2021).
- Assessment of factors affecting recanalisation rates.
- Evaluation of modified Treatment in Cerebral Infarction (mTICI) scores and modified Rankin Scale (mRS) at 6 months.
Main Results:
- Overall successful recanalisation rate was 72.33% (mTICI 2b or 3).
- Higher success rates were observed in inferior M2 division occlusions compared to superior.
- No assessed predictors reached statistical significance for recanalisation.
Conclusions:
- Mechanical thrombectomy is effective for M2 MCA occlusions.
- Inferior M2 MCA occlusions have a higher likelihood of successful recanalisation.
- Further research may be needed to identify predictors of success.
