title: Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience.
abstract: BACKGROUND
  Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment.
  
  
  OBJECTIVE
  To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers.
  
  
  METHODS
  We studied patients prospectively included in the SONIIA registry (years 2011-2012)-a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b-3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24-36 h; and good outcome as modified Rankin score (mRS) 0-2 at 3months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume.
  
  
  RESULTS
  Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289 ± 195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0-2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01).
  
  
  CONCLUSIONS
  Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.
authors.affiliation: Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alan
authors.initials: A
authors.lastname: Flores
authors.affiliation: Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tomasello
authors.affiliation: Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Cardona
authors.affiliation: Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: M Angeles
authors.initials: MA
authors.lastname: de Miquel
authors.affiliation: Department of Neurology, Hospital Universitari Germans Trias I Pujo, Badalona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Gomis
authors.affiliation: Department of Neurology, Hospital Universitari Germans Trias I Pujo, Badalona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Garcia Bermejo
authors.affiliation: Department of Neurology, Hospital Clínic I Provincial, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Obach
authors.affiliation: Department of Neurology, Hospital Clínic I Provincial, Barcelona, Spain.
authors.forename: Xabi
authors.initials: X
authors.lastname: Urra
authors.affiliation: Department of Neurology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Martí-Fàbregas
authors.affiliation: Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Cánovas
authors.affiliation: Department of Neurology, Hospital del Mar, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
authors.affiliation: Stroke Programme, Catalan Agency for Health Information, Assessment, and Quality, Barcelona, Spain.
authors.forename: Sònia
authors.initials: S
authors.lastname: Abilleira
authors.affiliation: Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Ribó
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Angiography; Stroke; Thrombectomy