[en] [en] BACKGROUND: The 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.
METHODS: Patients 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.
RESULTS: A 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.
CONCLUSIONS: Successful reperfusion of M2 occlusions reduced disability and mortality. However, safety is a concern, especially if the procedure failed.
Disciplines :
Neurology
Author, co-author :
Muszynski, Patricio; Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France
Anadani, Mohammad ; Washington University School of Medicine in St Louis, St Louis, Missouri, USA ; Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
Richard, Sébastien ; Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, Nancy, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, CHU Bordeaux, Bordeaux, France
Bourcier, Romain; Neuroradiology, University Hospital of Nantes, Nantes, France
Sibon, Igor; Neurology, Stroke Unit, CHU Bordeaux, Bordeaux, France
Dargazanli, Cyril; Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
Arquizan, Caroline; Neurology, CHRU Gui de Chauliac, Montpellier, France
Maïer, Benjamin; Interventional Neuroradiology, Rothschild Foundation, Paris, France
Blanc, Raphaël; Interventional Neuroradiology, Rothschild Foundation, Paris, France
Lapergue, Bertrand ; Neurology, Stroke Unit, Foch Hospital, Suresnes, France
Consoli, Arturo; Diagnostic and Therapeutic Neuroradiology, Foch Hospital, Suresnes, France
Eugene, Francois ; Neuroradiology, CHU Rennes, Rennes, France
Vannier, Stephane; Neurology, Stroke Unit, CHU Rennes, Rennes, France
Spelle, Laurent; Interventional Neuroradiolology, CHU Bicêtre, Le Kremlin-Bicêtre, France
Denier, Christian; Neurology, Stroke Unit, CHU Bicêtre, Le Kremlin-Bicêtre, France
Boulanger, Marion; Neurology, Stroke Unit, CHU Caen, Caen, France
Gauberti, Maxime; Neuroradiolology, CHU Caen, Caen, France
Saleme, Suzana; Neuroradiology, CHU Limoges, Limoges, France
Macian, Francisco; Neurology, Stroke Unit, CHU Limoges, Limoges, France
Clarençon, Frédéric; Sorbonne Université, Paris, France ; Neuroradiology, CHU Pitié-Salpêtrière, Paris, France
Rosso, Charlotte; Neurology, Stroke Unit, CHU Pitié-Salpêtrière, Paris, France
Naggara, Olivier; Neuroradiology, Hôpital St Anne, Paris, France
Turc, Guillaume; Neurology, Stroke Unit, Hôpital Saint Anne, Paris, France
Ozkul-Wermester, Ozlem; Neurology, Stroke Unit, CHU Rouen, Rouen, France
Papagiannaki, Chrisanthi; Interventional Neuroradiolology, CHU Rouen, Rouen, France
Viguier, Alain; Neurology, Stroke Unit, CHU Toulouse, Toulouse, France
Cognard, Christophe; Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
Le Bras, Anthony ; Radiology, CH Bretagne Atlantique, Vannes, France
Evain, Sarah; Neurology, Stroke Unit, CH Bretagne Atlantique, Vannes, France
Wolff, Valérie; Stroke Unit, CHU Strasbourg, Strasbourg, France
Pop, Raoul; Interventional Neuroradiolology, CHU Strasbourg, Strasbourg, France
Timsit, Serge; Neurology, Stroke Unit, CHU Brest, Brest, France
Gentric, Jean-Christophe; Interventionl Neuroradiolology, CHU Brest, Brest, France
Bourdain, Frédéric; Neurology, Stroke Unit, CH Côte Basque, Bayonne, France
Veunac, Louis; Radiolology, CH Côte Basque, Bayonne, France
Gory, Benjamin; Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France b.gory@chu-nancy.fr ; IADI, INSERM U1254, Université de Lorraine, Nancy, France
Finitsis, Stephanos Nikolaos ; Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece ; Radiology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
Menon BK, Hill MD, Davalos A, et al. Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. J Neurointerv Surg 2019;11:1065-9.
Alawieh A, Kellogg RT, Chatterjee AR, et al. Technical and clinical outcomes after thrombectomy for the various segments of the middle cerebral artery. World Neurosurg 2019;128:e445-53.
Bhogal P, Bucke P, AlMatter M, et al. A comparison of mechanical thrombectomy in the M1 and M2 segments of the middle cerebral artery: a review of 585 consecutive patients. Interv Neurol 2017;6:191-8.
Coutinho JM, Liebeskind DS, Slater L-A, et al. Mechanical thrombectomy for isolated M2 occlusions: a post hoc analysis of the STAR, SWIFT, and SWIFT PRIME studies. AJNR Am J Neuroradiol 2016;37:667-72.
de Havenon A, Narata AP, Amelot A, et al. Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study. J Neurointerv Surg 2020;107:neurintsurg-2020-016427.
Dorn F, Lockau H, Stetefeld H, et al. Mechanical thrombectomy of M2-occlusion. J Stroke Cerebrovasc Dis 2015;24:1465-70.
Gory B, Lapergue B, Blanc R, et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Stroke 2018;49:461-4.
Li G, Huang R, Li W, et al. Mechanical thrombectomy with second-generation devices for acute cerebral middle artery M2 segment occlusion: a meta-analysis. Interv Neuroradiol 2020;26:187-94.
Sarraj A, Sangha N, Hussain MS, et al. Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment. JAMA Neurol 2016;73:1291-6.
Miura M, Yoshimura S, Sakai N, et al. Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan registry 2. J Neurointerv Surg 2019;11:964-9.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344-418.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-29.
Anadani M, Alawieh A, Vargas J, et al. First attempt recanalization with ADAPT: rate, predictors, and outcome. J Neurointerv Surg 2019;11:641-5.
Khunte M, Wu X, Payabvash S, et al. Cost-effectiveness of endovascular thrombectomy in patients with acute stroke and M2 occlusion. J Neurointerv Surg 2020. doi:10.1136/neurintsurg-2020-016765. [Epub ahead of print: 19 Oct 2020].
Spiotta AM, Fiorella D, Arthur AS, et al. The semiotics of distal thrombectomy: towards a TICI score for the target vessel. J Neurointerv Surg 2019;11:213-4.
Atchaneeyasakul K, Malik AM, Yavagal DR, et al. Thrombectomy outcomes in acute ischemic stroke due to middle cerebral artery M2 occlusion with stent retriever versus aspiration: a multicenter experience. Interv Neurol 2020;8:180-6.
