Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience

Abstract

Background and Purpose: In this article, we present our experience with the recanalization of the middle cerebral artery (MCA), we hypothesize that there are higher rates of recanalization with fewer stent retriever passes and better clinical outcomes in patients with division MCA occlusions. A more complex anatomy at the bifurcation may prevent a faster recanalization in main trunk MCA occlusions. Methods: We retrospectively identified consecutive patients admitted with MCA occlusions who underwent mechanical thrombectomy using stent retrievers. We categorized patients into division MCA and main trunk MCA occlusions based on angiography. Variables were compared between the groups. We further analyzed patients with trunk MCA occlusions to identify reasons for delays in recanalization. Results: There were 32 MCA occlusions that underwent mechanical thrombectomy and eligible for the analysis during the study period. Of those, 11 were main trunk MCA occlusions. Univariate analysis disclosed a trend toward a lower GP-to-recanalization time (p = 0.05) and a lower number of passes required for recanalization in division MCA occlusions. However, there was a significantly better outcome in patients with division MCA occlusion after multivariate analysis. Analyzing main trunk MCA occlusion data, we found that the need for more than one pass to achieve recanalization led to a trend toward a longer GP-to-recanalization time and a worse outcome. When the stent was placed in the dominant division, the chances of recanalization were significantly higher. Conclusions: Division MCA occlusions have higher recanalization rates with fewer stent retriever passes and better clinical outcomes than main trunk MCA occlusions, likely due to a more favorable anatomy. Measures like placing the stent retriever in the dominant division may decrease recanalization times and improve clinical outcomes in main trunk MCA occlusions.

Comparison of stent retriever thrombectomy using 3‐dimensional patient‐specific models of intracranial circulation with actual middle cerebral artery occlusion thrombectomy cases

“…[8][9][10] Location of the occlusion; tortuosity and angulation of the affected intracranial vessels; clot length, shape, and composition; as well as clot burden score have all been identified as potential factors affecting the outcome of SR thrombectomy. [11][12][13][14] Most of the proposed factors that seem to affect recanalization success have been studied individually, and conflicting data derived from clinical versus in vitro studies using 3-dimensional printed models of intracranial circulation currently exist. We have previously designed and validated an in vitro model of anterior circulation LVO that closely resembles normal human physiological cervical and intracranial vessels and allows easy and reliable delivery of a clot to the target site for SR thrombectomy.…”

“…A great deal of research has been focused on the identification of clinical and imaging factors that could predict technical outcomes of thrombectomy using a particular SR device or technique 8–10 . Location of the occlusion; tortuosity and angulation of the affected intracranial vessels; clot length, shape, and composition; as well as clot burden score have all been identified as potential factors affecting the outcome of SR thrombectomy 11–14 . Most of the proposed factors that seem to affect recanalization success have been studied individually, and conflicting data derived from clinical versus in vitro studies using 3‐dimensional printed models of intracranial circulation currently exist.…”