Technical and Clinical Outcomes After Thrombectomy for the Various Segments of the Middle Cerebral Artery

Alawieh, Ali; Kellogg, Ryan T; Chatterjee, Arindam; Korson, Clayton; Lajthia, Orgest; Anadani, Mohammad; Lena, Jonathan; Spiotta, Alejandro M

doi:10.1016/j.wneu.2019.04.175

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…Importantly, almost 50% of the patients required only one pass of aspiration alone or aspiration plus 3D as the frontline procedural technique, and more than 70% of patients had a good functional outcome (mRS 0–2) at 90 days. Our results are corroborated by results from previous studies that reported the results of aspiration thrombectomy for M2 MCA occlusion and used prospectively collected data ( Supplementary Table 1 ) ( 13 , 14 , 16 , 19 – 24 ).…”

Section: Discussionsupporting

confidence: 90%

“…In the treatment of patients with M2 MCA occlusion, outcomes appear to be better for endovascular therapy ( 9 ), and for mechanical thrombectomy in particular ( 10 , 11 ), than for best medical care. In studies comparing mechanical thrombectomy ( 11 , 12 ) or aspiration thrombectomy ( 13 – 16 ) between MCA occlusion sites, fewer data are available for M2 MCA occlusion than for M1 MCA occlusion. The objective of this study was to evaluate, by means of prospectively collected data, the safety and efficacy of aspiration thrombectomy in patients with M2 MCA occlusion.…”

Section: Introductionmentioning

confidence: 99%

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Aspiration thrombectomy of M2 middle cerebral artery occlusion to treat acute ischemic stroke: A core lab–adjudicated subset analysis from the COMPLETE registry and literature review

et al. 2023

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BackgroundAlthough the benefits of aspiration thrombectomy for treating acute ischemic stroke caused by proximal large vessel occlusion have been established, fewer data are available for evaluating aspiration thrombectomy of distal occlusion. The objective of this study was to evaluate, by means of prospectively collected data, the safety and efficacy of aspiration thrombectomy in patients with M2 middle cerebral artery (MCA) occlusion.MethodsThis study is a subset analysis of a global prospective multicenter observational registry that included patients who presented with either anterior or posterior large vessel occlusion and were eligible for mechanical thrombectomy using the Penumbra System including the Penumbra 3D Revascularization Device. For this analysis, all patients in the registry with M2 MCA occlusion were included.ResultsOf the 650 patients in the registry, 113 (17.4%) had M2 MCA occlusion. The rate of a modified treatment in cerebral infarction score of 2b to 3 after the procedure was 79.6% (90/113), the rate of a modified Rankin Scale score of 0–2 at 90 days was 72.5% (79/109), and the all-cause mortality rate at 90 days was 8.8% (10/113). Device-related serious adverse events occurred in one patient (0.9%) within 24 h and in two patients (1.8%) overall. Procedure-related serious adverse events occurred in four patients (3.5%) within 24 h and in six patients (5.3%) overall (nine events).ConclusionFor appropriately selected patients, aspiration thrombectomy for acute ischemic stroke due to M2 MCA occlusion was safe and effective, with high rates of technical success and good functional outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Aspiration thrombectomy of M2 middle cerebral artery occlusion to treat acute ischemic stroke: A core lab–adjudicated subset analysis from the COMPLETE registry and literature review

et al. 2023

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“…Our study adds to the growing literature supporting the efficacy of EVT in M2 occlusions,1–10 as well as its cost-effectiveness 14. Li et al performed a meta-analysis of studies evaluating the clinical and safety outcomes of EVT for M2 occlusions 8.…”

Section: Discussionmentioning

confidence: 84%

“…The best treatment strategy for M2 occlusion is uncertain due to the lack of randomized trials focusing on this subgroup of patients with M2 occlusion. However, several studies have reported the efficacy and safety of endovascular treatment (EVT) in M2 occlusions with conflicting results 1–10. Moreover, a HERMES meta-analysis suggested a potential benefit from EVT compared with medical therapy in M2 occlusions, although it was limited by small sample size 1.…”

Section: Introductionmentioning

confidence: 99%

Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results

Muszynski

Anadani

Richard

et al. 2021

J NeuroIntervent Surg

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BackgroundThe predictors of successful reperfusion and the effect of reperfusion after endovascular treatment (EVT) for M2 occlusions have not been well studied. We aimed to identify predictors of successful reperfusion and the effect of reperfusion on outcomes of EVT for M2 occlusions in current practice.MethodsPatients with acute ischemic stroke due to isolated M2 occlusions who were enrolled in the prospective multicenter Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and March 2020 were included. The primary outcome was a favorable outcome, defined as modified Rankin Scale (mRS) score of 0–2 at 90 days. Successful reperfusion was defined as an improvement of ≥1 points in the modified Thrombolysis In Cerebral Infarction score between the first and the last intracranial angiogram.ResultsA total of 458 patients were included (median National Institutes of Health Stroke Scale (NIHSS) score 14; 61.4% received prior intravenous thrombolysis). Compared with the non-reperfused patients, reperfused patients had an increased rate of excellent outcome (OR 2.3, 95% CI 0.98 to 5.36; p=0.053), favorable outcome (OR 2.79, 95% CI 1.31 to 5.93; p=0.007), and reduced 90-day mortality (OR 0.39, 95% CI 0.19 to 0.79; p<0.01). Admission NIHSS score was the only predictor of successful reperfusion. First-line strategy was not a predictor of successful reperfusion or favorable outcome, but the use of a stent retriever, alone or with an aspiration catheter, was associated with higher rates of procedural complications and 90-day mortality.ConclusionsSuccessful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.

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“…4). Generally, this expansion of the treatment has been safe and effective [74][75][76], even though it is less well studied. It also remains to be studied whether EVT in more distal segments should follow the same procedural principles, or needs dedicated techniques [77,78].…”

Section: Improving Endovascular Treatment Furthermentioning

confidence: 99%

Endovascular thrombectomy for acute ischemic stroke

et al. 2022

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This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of care on a global scale, is one of the major achievements in modern medicine. It was possible thanks to the establishment of a scientific framework for patient selection, assessment of stroke severity and outcome, technical development by dedicated physicians and the MedTech industry, including noninvasive imaging for patient selection, and radiological outcome evaluation. A series of randomized controlled trials on EVT in addition to intravenous thrombolytics, with overwhelmingly positive results for anterior circulation stroke within 6 h of onset regardless of patient characteristics with a number needed to treat of less than 3 for any positive shift in outcome, paved the way for a rapid introduction of EVT into clinical practice. Within the “extended” time window of 6–24 h, the effect has been even greater for patients with salvageable brain tissue according to perfusion imaging with a number needed to treat below 2. Even so, EVT is only available for a small portion of stroke patients, and successfully recanalized EVT patients do not always achieve excellent functional outcome. The major challenges in the years to come include rapid prehospital detection of stroke symptoms, adequate clinical and radiological diagnosis of severe ischemic stroke cases, enabling effective recanalization by EVT in dedicated angiosuites, followed by personalized post‐EVT stroke care.

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Technical and Clinical Outcomes After Thrombectomy for the Various Segments of the Middle Cerebral Artery

Cited by 16 publications

References 22 publications

Aspiration thrombectomy of M2 middle cerebral artery occlusion to treat acute ischemic stroke: A core lab–adjudicated subset analysis from the COMPLETE registry and literature review

Aspiration thrombectomy of M2 middle cerebral artery occlusion to treat acute ischemic stroke: A core lab–adjudicated subset analysis from the COMPLETE registry and literature review

Endovascular reperfusion of M2 occlusions in acute ischemic stroke reduced disability and mortality: ETIS Registry results

Endovascular thrombectomy for acute ischemic stroke

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