Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery
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ORIGINAL ARTICLE
Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery Retrospective Analysis of the Tama-REgistry of Acute endovascular Thrombectomy (TREAT) Tomoyuki Nakano1 · Keigo Shigeta1 · Takahiro Ota2 · Tatsuo Amano3 · Masayuki Ueda4 · Yuji Matsumaru5 · Yoshiaki Shiokawa6 · Teruyuki Hirano3 Received: 19 April 2019 / Accepted: 7 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Background The efficacy of mechanical thrombectomy in the treatment of occlusions of the second segment of the middle cerebral artery (M2) has not been firmly established. Methods This study analyzed data from patients who had undergone mechanical thrombectomy for the first segment of the middle cerebral artery (M1) and M2 occlusion from the Tama-REgistry of Acute endovascular Thrombectomy (TREAT) between January 2015 and March 2017, which is a multicenter database in the Tama area of Tokyo, Japan. The M1 and M2 occlusions were compared in order to evaluate the safety and efficacy of M2 thrombectomy. Results A total of 515 patients were registered, whereby 160 patients with M1 occlusion and 51 patients with M2 occlusion were included. While the puncture-to-reperfusion time was longer in the M2 occlusions (median 43 min, range 30–61 min vs. median 60 min, range 38–79 min, p = 0.01), no significant differences were seen in the proportion of patients with successful reperfusion, postoperative hemorrhagic complications and good outcome (modified Rankin scale Ä2 at 90 days). Younger age was the only independent factor associated with good outcome in patients with M2 occlusions as determined by the multivariate analysis (p = 0.033, odds ratio 0.91, 95% confidence interval 0.83–0.99). Conclusion The outcome and the safety profile of mechanical thrombectomy for M2 occlusions are favorable and comparable to those of the M1 occlusion thrombectomy.
Keywords M2 thrombectomy · Endovascular therapy · Acute ischemic stroke · Distal vessel occlusion · Reperfusion
Tomoyuki Nakano
[email protected] 1
2
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Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256, Midori-cho, Tokyo, Tachikawa-shi 190-0014, Japan
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Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashi-dai, Tokyo, Fuchu-shi 183-8524, Japan
Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashi-dai, Tokyo, Fuchu-shi 183-8524, Japan
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Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka-shi 181-8611, Japan
Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, 2-1-1, Amakubo, Ibaraki, Tsukuba 305-8576, Japan
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Department of Neurosurgery, Kyorin University, 6-20-2, Shinkawa, Tokyo, Mitaka-shi 181-8611, Japan
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T. Nakano et al.
Introduction There has been significant progress in the endovascular treatment of large vessel occlusion (LVO) in the past few decades. Since the publication o
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