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Degree of subarachnoid hemorrhage affects clinical outcome after mechanical thrombectomy for M2 occlusion
Fumiaki Oka1, Takuma Nishimoto1, Naomasa Mori1
1Department of Neurosurgery, Yamaguchi Graduate School of Medicine, Ube, Yamaguchi, Japan.
Purpose:
The prognostic relevance of post-mechanical thrombectomy (MT) subarachnoid hemorrhage (SAH) remains controversial. This study aimed to investigate whether the thickness of the SAH clot affects clinical outcomes following MT for M2 occlusion.
Methods:
A retrospective analysis was conducted on a prospective database of patients who underwent MT for isolated M2 occlusion. Patients were categorized into three groups based on the presence and thickness of SAH. Clinical and angiographical characteristics and outcomes were compared.
Results:
Of the 36 patients included, SAH was observed in 15 (42%). When comparing patients with no SAH (grade 0) or thin SAH (grade 1) (N = 28) with those who had thick SAH (grade 2) (N = 8), patients with Grade 2 SAH required a higher number of passes and had a more severe angulation at M2. Patients with SAH Grade 2 had significantly worse NIHSS scores at 24 h (median, 4 vs. 14), but only one patient was identified as having a symptomatic intracranial hemorrhage. Patients with SAH Grade 2 were found to have a lower rate of favorable outcome (modified Rankin scale 0-2) (23% vs. 75%, P = 0.0026) and higher mortality (25% vs. 0%, P = 0.0499) at 90 days.
Conclusion:
The study found that thick SAH prevents clinical recovery after MT for M2 occlusion, even in cases of successful recanalization, and is associated with an unfavorable outcome. Thick SAH after MT is also linked to an increase in the number of passes and severe angulation at the M2 segment.
Insights
Thick subarachnoid hemorrhage (SAH) after mechanical thrombectomy (MT) for M2 occlusion is linked to worse outcomes. Even with successful recanalization, significant SAH hinders recovery and increases mortality.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Post-mechanical thrombectomy (MT) subarachnoid hemorrhage (SAH) prognostic relevance is debated.
- M2 occlusion stroke treatment involves MT, but SAH complications require further investigation.
Purpose of the Study:
- To determine if SAH clot thickness impacts clinical outcomes after MT for M2 occlusion.
- Investigate the association between SAH severity and functional recovery post-MT.
Main Methods:
- Retrospective analysis of a prospective database of patients undergoing MT for M2 occlusion.
- Patients were stratified by SAH presence and thickness (Grade 0, 1, 2).
- Comparison of clinical and angiographical data and outcomes across SAH groups.
Main Results:
- SAH occurred in 42% of patients (N=15/36).
- Thick SAH (Grade 2) was associated with more passes, severe M2 angulation, worse NIHSS scores at 24h (median 14 vs. 4), and lower favorable outcome rates (23% vs. 75%).
- Grade 2 SAH showed significantly higher 90-day mortality (25% vs. 0%).
Conclusions:
- Thick SAH post-MT for M2 occlusion predicts poor clinical recovery, irrespective of recanalization success.
- Severe SAH is linked to increased procedural complexity and unfavorable neurological outcomes.
- Thick SAH represents a significant negative prognostic factor in M2 occlusion stroke treated with MT.
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