Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement
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ORIGINAL ARTICLE
Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement Vivien Lorena Ivan 1 & Christian Rubbert 1 & Julian Caspers 1 & John-Ih Lee 2 & Michael Gliem 2 & Sebastian Jander 2 & Bernd Turowski 1 & Marius Kaschner 1 Received: 6 November 2019 / Accepted: 13 April 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Endovascular treatment (EVT) is an established procedure in patients with acute ischemic stroke due to occlusion of the proximal M1-segment of middle cerebral artery. The assessment of distal thrombectomy in daily clinical routine has not yet been sufficiently evaluated. Methods Patients with M2-segment-occlusions treated by EVT in the local department (January 2012–December 2017) were included (n = 57, mean National-Institutes-of-Health-Stroke-Scale of 11, range 0–20). Patients were grouped according to localization of M2-occlusion (Cohort A (n = 14): central region only, B (n = 24): central region and involvement of frontal vessels, C (n = 19): parietal, occipital, and/or temporal vessels). Differences in proximal (M2-trunk, n = 34) and distal (M2branches, n = 23) occlusions were also examined. Reperfusion (Thrombolysis-In-Cerebral-Infarction (TICI)), early clinical outcome at discharge (modified Rankin Scale (mRS)), and complications (hemorrhage, new emboli) were noted. Result Successful reperfusion (TICI2b–3) was found in 49 patients (86.0%). Favorable early clinical outcome (mRS0–2) was achieved in n = 19 (37.7%). Compared to admission, mRS at discharge improved significantly (median (admission) 5 vs. median (discharge) 4, p < 0.001). Early clinical outcome was more favorable in patients with better reperfusion (TICI2b-3: mean mRS 3 ± 1.7 vs. TICI0–2a: mean mRS 4.4 ± 1.4, p = 0.037). Six (10.5%) patients suffered from symptomatic intracranial hemorrhage during treatment or hospitalization. Four patients died (7.0%). No significant differences in favorable clinical outcome (mRS ≤ 2: Cohort A 42.9%, B 50.0%, C 16.7%, p = 0.4; χ2-test) or periinterventional complications were found with regard to vessel involvement. Conclusion EVT in patients with acute M2-occlusion is safe and leads to a significant clinical improvement at discharge. No significant differences in clinical outcome or complications were found with regard to the localization of the M2-occlusion. Keywords Thrombectomy . Endovascular treatment . M2-segment occlusions
Introduction The five major studies for the treatment of acute ischemic stroke in the anterior circulation from 2015 (MR CLEAN, EXTEND IA, ESCAPE, REVASCAT, SWIFT PRIME) demonstrated a significant benefit of treatment with endovascular therapy (EVT) and intravenous thrombolysis (IVT) versus * Vivien Lorena Ivan [email protected] 1
Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
2
Department of Neurology, Heinrich-Heine-University, Medical faculty, Düsseldorf, Germany
IVT alone. Owing to these
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