M1 is not M1 in ischemic stroke: the disability-free survival after mechanical thrombectomy differs significantly between proximal and distal occlusions of the middle cerebral artery M1 segment

Behme, Daniel; Kowoll, Annika; Weber, W.; Mpotsaris, Anastasios

doi:10.1136/neurintsurg-2014-011212

Cited by 39 publications

(42 citation statements)

References 18 publications

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“…The 90-day mortality rate was 55.6% in patients with DT<5 mm and 4.8% in patients with DT>30 mm (P=0.007; Figure 3A and 3B). There was no significant correlation using Spearman ρ between DT and the short-term change in neurological status (R=0.037; P=0.696), defined as the difference between the initial NIHSS score and the NIHSS score on day 7 after IVT (eg, DT<5 mm: NIHSS score improvement 4 [−2 to 8]; DT>30 mm: NIHSS score improvement 3 [1][2][3][4][5][6][7][8][9][10]). …”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, they used a complicated analytic method based on evaluation of 4D-CTA images on dedicated workstations, which makes clinical application of their method in the acute setting difficult. In another angiography-based study, Behme and colleagues 10 analyzed patients treated by mechanical thrombectomy after M1 occlusion. They split the location of the M1 occlusion into 2 groups: a proximal group with occlusion of the lenticulostriate perforators visible on digital subtraction angiography, and a distal group without occlusion of the lenticulostriate perforators.…”

Section: Discussionmentioning

confidence: 99%

“…The likelihood of an unfavorable outcome was reported to increase with a more proximal occlusion in patients treated with IVT or mechanical thrombectomy. 8,10 These studies used analyses based on the occluded MCA segment and restricted their comparisons to M1 segment occlusion with or without M2 segment occlusion. In their CT-based study, Rohan and colleagues 8 found that the length of M1 occlusion was significantly correlated with the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, this method only addresses the M1 segment, and the precise location of thrombus in the other segments remains unclear. Introduction of an objective, easy-to-assess, and precise method of describing the location of thrombus in the MCA is therefore important.…”

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confidence: 99%

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Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

Friedrich

Gawlitza

Schob

et al. 2015

Stroke

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Background and Purpose— In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion. Methods— Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed. Results— DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm ( P <0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA ( P <0.001). Conclusion— DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

Friedrich

Gawlitza

Schob

et al. 2015

Stroke

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“…17 The exact thrombus location, being more proximal or distal within the MCA M1 segment, was demonstrated to be a significant determinant for clinical outcome, however not for recanalization success. 18 To date, no evidence of vessel anatomy influencing recanalization success exists, though experienced interventionalists report that MT with stent retrievers is less likely to be successful in patients with strongly curved vessels. Zhu et al 19 reported that vessel branching and curvature are important determinants of recanalization success; however, their work was based on indirect MR imaging findings and focused on thrombectomy by using the Merci retriever (Concentric Medical, Mountain View, California), a first-generation device, which is now obsolete in most cases.…”

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confidence: 99%

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

Schwaiger

Gersing

Zimmer

et al. 2015

AJNR Am J Neuroradiol

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Einfluss der Distanz zum Thrombus bei akutem Verschluss der Arteria cerebi media

et al. 2020

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Zusammenfassung Hintergrund Die Therapiestrategie von Patienten mit akutem Schlaganfall der Arteria cerebri media (ACM) wird durch die Lokalisation der Okklusion beeinflusst. Diese Studie zielte darauf ab, die klinischen Ergebnisse bei Patienten mit akutem ischämischem ACM-Verschluss, die mit endovaskulärer mechanischer Thrombektomie (EVT) behandelt wurden, entsprechend dem Okklusionsort zu analysieren. Methoden Es wurden 54 Patienten (Alter: 73 ± 15 Jahre; 59 % weiblich), die aufgrund eines akuten ACM-Verschlusses mittels EVT behandelt wurden, eingeschlossen. In koronar reformatierten MIP-Bildern (Maximumintensitätsprojektion) der CT-Angiographie wurde die Distanz zum Thrombus (DT), also dem Abstand vom Karotis‑T zum Beginn des Thrombus, gemessen. Die Korrelation zwischen DT, klinischer Symptomatik und klinischem Outcome der Patienten mit EVT-Therapie wurde analysiert. Ergebnisse Die DT korrelierte mit der klinischen Symptomatik, gemessen an der National Institutes of Health Stroke Scale (NIHSS; p = 0,017; R = −0,324), bei Aufnahme. Sie korrelierte auch mit der modifizierten Rankin-Skala nach 90 Tagen (90-Tage-mRS; p = 0,014; R = −0,333). Die DT ist ein Prädiktor für ein gutes klinisches Outcome (mRS nach 90 Tagen) nach EVT; Odds-Ratio: 1,113 (p = 0,02; 95 % Konfidenzintervall [KI] 1,017–1,219). Eine DT >10 mm korrelierte signifikant (p = 0,036) mit einem guten klinischen Outcome (90-Tage-mRS ≤2). Schlussfolgerung Die DT korreliert mit der klinischen Symptomatik von Patienten mit akutem ACM-Verschluss. Darüber hinaus sie ein unabhängiger Prädiktor für das klinische Outcome von Patienten, die an einem akuten Schlaganfall durch ACM-Okklusion leiden.

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M1 is not M1 in ischemic stroke: the disability-free survival after mechanical thrombectomy differs significantly between proximal and distal occlusions of the middle cerebral artery M1 segment

Cited by 39 publications

References 18 publications

Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

Distance to Thrombus in Acute Middle Cerebral Artery Occlusion

The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke

Einfluss der Distanz zum Thrombus bei akutem Verschluss der Arteria cerebi media

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