Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2

Miura, Masatomo; Yoshimura, Shinichi; Sakai, Nobuyuki; Yamagami, Hiroshi; Nagao, Yoichiro; Morimoto, Takeshi

doi:10.1136/neurintsurg-2018-014627

Cited by 28 publications

(15 citation statements)

References 27 publications

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“…The mortality rate at three months was 30%, which was higher than rates previously reported (3.8%-19.6%), and it was caused by an unexpected high rate of pneumonia (Table 1). A good functional outcome was observed in 50% of the patients and also was similar to previous studies (52.6%-96.8%) (Table 4 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] ).…”

Section: Discussionsupporting

confidence: 90%

“…19 More recently, a subanalysis of 184 M2 thrombectomies of the RESCUE (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism)-Japan registry was published that showed 3.8% sICH, 3.8% mortality and 57% good outcome after three months. 22 Indication for thrombectomy for all patients with M2 occlusions is controversial because M2 occlusions are not a single clinical setting, but a clinical spectrum based on the type of M2 occluded branch (bifurcation or trifurcation, dominant or nondominant), site of M2 branch occluded (proximal or distal), length of the clot, collateral status, severity of neurologic symptoms and ASPECTS regions to be saved. A trial aiming to compare IV rTPA vs thrombectomy should be designed taking into account all the variables described above.…”

Section: Discussionmentioning

confidence: 99%

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Thrombectomy for M2 occlusions and the role of the dominant branch

et al. 2019

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Introduction The benefits of thrombectomy for occlusion of M2 segments remain controversial. The aim of this study is to assess thrombectomy’s efficacy and safety in patients with M2 segment occlusion and associations between occlusion sites and anatomic variations of M1 division. Materials and methods A prospective series of 30 patients with acute ischemic stroke (AIS) resulting from M2 segment occlusion of the middle cerebral artery (MCA) who underwent thrombectomy was analyzed. The primary endpoint was assessed by the Extended Treatment in Cerebral Infarction scale (eTICI). The secondary endpoints were the incidence of symptomatic hemorrhagic transformation (sICH), mortality and good functional outcome at three months. Results The mean patient age was 69.2 years. The mean National Institutes Health Stroke Scale score (NIHSS) upon hospital admission was 16. The recanalization rates were eTICI 2b/3 in 90% and 2c/3 in 60% of the patients. Total recanalization of the M2 branch was achieved in 53% of patients. sICH incidence was 6.6%, the mortality rate was 30%, and a good functional outcome (mRS ≤2) was observed in 50% of the patients. Twenty-seven patients (90%) had a dominant M2 branch and all were occluded. Regarding the site of M2 occlusions, 74% of patients had proximal M2 occlusions. Conclusions Thrombectomy appears to be a safe and effective method for the treatment of acute M2 segment occlusions of the MCA. Most of the cases had a dominant M2 branch, and all of them were occluded. Larger studies are needed to verify the benefits of thrombectomy for different settings of M2 occlusions.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Thrombectomy for M2 occlusions and the role of the dominant branch

et al. 2019

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“… 3 In a final study of the RESUCE-Japan Registry 2 cohort, there were 188 untreated M2 occlusions, who had a higher 50.5% rate of good outcome at 90 days. 18 Compared with previously reported data, the outcomes for patients with M2 occlusion with AIS treated with EVT in ARISE II were excellent. For example, in ARISE II, good outcome (mRS score 0–2) at 90 days was seen in 70.2% of M2 occlusions.…”

Section: Discussionmentioning

confidence: 58%

Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study

Havenon

Narata

Amelot

et al. 2020

J NeuroIntervent Surg

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BackgroundThe benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.ObjectiveTo compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.MethodsWe performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0–2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion.ResultsWe included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87).ConclusionIn ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.

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“…14) In our case, we use 170 ml of safety of MT for patients with M2 segment occlusion have not been established; however, Miura et al suggested the efficacy and safety of MT for patients with M2 segment occlusion compared with medical treatment. 11) After a discussion about the efficacy and the complication of MT for MCA M2 segment occlusion with her husband, we decided to let her receive MT. The maternal outcome was good, but the fetal outcome was finally unfavorable.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: A Case Report

Moriyama

Sugiura

Hayashi

et al. 2021

JNET

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Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) are effective treatments for acute ischemic stroke (AIS). However, the treatment for AIS in pregnancy is not established because no clinical trials have included pregnant patients. We present a case of middle cerebral artery (MCA) M2 segment occlusion in pregnancy treated with IV thrombolysis and endovascular therapy. Case Presentation: A 36-year-old woman being 6 weeks pregnant presented with right-sided hemiparesis and aphasia. MRI showed a high-intensity area on diffusion-weighted imaging of the left parietal lobe, and MRA showed left MCA M2 segment occlusion. She underwent IV rt-PA and MT and achieved thrombolysis in cerebral infarction 2b revascularization without complications. The protein S concentration was lower than that in the physiological changes during pregnancy. She was diagnosed with embolic stroke related to coagulopathy in pregnancy, and she underwent anticoagulation. At the 3-month follow-up, the modified Rankin Scale was 0. She miscarried at 4 months, and the fetal death was presumed to be obstetric cause. Conclusion: IV rt-PA and MT may be effective and safe treatments for pregnant patients. Estimated fetal radiation exposure during MT is low and is presumed not to affect fetal development. We should mitigate the radiation dose and reduce the dose of iodinated contrast agents, particularly in pregnant patients.

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Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2

Cited by 28 publications

References 27 publications

Thrombectomy for M2 occlusions and the role of the dominant branch

Thrombectomy for M2 occlusions and the role of the dominant branch

Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Pregnancy: A Case Report

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