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Updated: Sep 9, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Clinical outcomes and independently adjudicated results of M2 aspiration thrombectomy: a subgroup analysis from the
Justin R Mascitelli1, Reade Andrew De Leacy2, William Mack3
1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA jmascite@gmail.com.
Background:
The ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions) and DISTAL (Endovascular Therapy plus Best Medical Treatment vs Best Medical Treatment Alone for Medium Vessel Occlusion Stroke) trials failed to demonstrate the superiority of endovascular thrombectomy over best medical management for medium and small vessel occlusions. Potential limitations of these trials include older patient populations, lower presenting National Institutes of Health Stroke Scale (NIHSS) scores, higher rates of premorbid disability, delayed revascularization times, inclusion of both medium and small vessel occlusions, and widespread use of stent retrievers. Here we present M2 occlusion data from the Imperative Trial, evaluating aspiration thrombectomy with the Zoom System.
Methods:
The Imperative Trial is a prospective, multicenter, single-arm trial with independent core lab and safety board adjudication, evaluating aspiration thrombectomy with the Zoom System (Imperative Care, Campbell, CA, USA) for large vessel, including M2, occlusions. This subanalysis includes patients with primary M2 occlusions. Angiographic outcomes were defined as modified Treatment in Cerebral Infarction (mTICI) score ≥2b (good) and ≥2c (excellent). Clinical outcomes were defined as modified Rankin Scale score (mRS) 0-2 (good) and 0-1 (excellent) at 90 days. Safety was assessed by all-cause mortality, symptomatic intracranial hemorrhage (sICH), and all hemorrhage.
Results:
Of 260 enrolled patients, 25% (65/260) had primary M2 occlusions. Median age was 69 years; median NIHSS was 13. Good and excellent reperfusion were achieved in 88% (57/65) and 66% (43/65), respectively. At 90 days, good and excellent clinical outcomes occurred in 62% (39/63) and 56% (35/63), respectively. Mortality, sICH, and any hemorrhage were 4.6% (3/65), 1.5% (1/65), and 18% (12/65), respectively.
Conclusions:
The Zoom System demonstrated excellent safety and efficacy in M2 occlusions. These findings support aspiration thrombectomy for M2 occlusions as a viable treatment in well-selected patients.
Insights
Aspiration thrombectomy using the Zoom System shows promising results for M2 occlusions, achieving high reperfusion and good clinical outcomes. This study supports aspiration thrombectomy as a safe and effective treatment for selected M2 occlusion stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Previous trials like ESCAPE-MeVO and DISTAL did not show endovascular thrombectomy superiority for medium and small vessel occlusions.
- Limitations in prior studies included older populations, lower NIHSS scores, and delayed treatment times.
- M2 occlusions, a subset of medium vessel occlusions, require specific evaluation for effective treatment.
Purpose of the Study:
- To evaluate the safety and efficacy of aspiration thrombectomy with the Zoom System for M2 occlusions.
- To present subanalysis data from the Imperative Trial focusing on primary M2 occlusions.
Main Methods:
- Prospective, multicenter, single-arm trial (Imperative Trial) evaluating the Zoom System for large vessel occlusions.
- Subanalysis included patients with primary M2 occlusions, with independent core lab and safety board adjudication.
- Outcomes assessed included angiographic reperfusion (mTICI ≥2b/≥2c) and clinical outcomes (mRS 0-2/0-1 at 90 days).
Main Results:
- 25% (65/260) of enrolled patients had primary M2 occlusions.
- Good (≥2b) and excellent (≥2c) reperfusion rates were 88% and 66%, respectively.
- Good (mRS 0-2) and excellent (mRS 0-1) clinical outcomes at 90 days were 62% and 56%, respectively, with low mortality (4.6%) and sICH (1.5%).
Conclusions:
- The Zoom System demonstrated excellent safety and efficacy in treating M2 occlusions.
- Aspiration thrombectomy with the Zoom System is a viable treatment option for well-selected M2 occlusion stroke patients.
- These findings offer a potential alternative to previous thrombectomy approaches for M2 occlusions.
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