title: Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies.
abstract: OBJECTIVE
  Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies.
  
  
  METHODS
  We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3.
  
  
  RESULTS
  We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64).
  
  
  CONCLUSIONS
  Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.
authors.affiliation: From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.).
authors.forename: J M
authors.identifier: http://orcid.org/0000-0002-8284-982X
authors.initials: JM
authors.lastname: Coutinho
authors.affiliation: Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California.
authors.forename: D S
authors.identifier: http://orcid.org/0000-0002-5109-8736
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.).
authors.forename: L-A
authors.identifier: http://orcid.org/0000-0002-1140-8664
authors.initials: LA
authors.lastname: Slater
authors.affiliation: Marcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: R G
authors.identifier: http://orcid.org/0000-0003-4532-153X
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Department of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee.
authors.forename: B W
authors.identifier: http://orcid.org/0000-0002-3403-428X
authors.initials: BW
authors.lastname: Baxter
authors.affiliation: Department of Neurosurgery (E.I.L., A.H.S.).
authors.forename: E I
authors.identifier: http://orcid.org/0000-0002-6208-3724
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (A.H.S.), State University of New York at Buffalo, Buffalo, New York.
authors.forename: A H
authors.identifier: http://orcid.org/0000-0002-9519-0059
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Departments of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-9060-2109
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Department of Neurology (O.O.Z.), Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: O O
authors.identifier: http://orcid.org/0000-0003-4881-4698
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: Department of Neurosciences (A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-2949-5679
authors.initials: A
authors.lastname: Davalos
authors.affiliation: Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9187-1375
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Division of Interventional Neuroradiology (R.J.).
authors.forename: R
authors.identifier: http://orcid.org/0000-0001-7389-6352
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Departments of Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: J
authors.identifier: http://orcid.org/0000-0003-1953-9033
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: J L
authors.identifier: http://orcid.org/0000-0001-9141-2251
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.) Neurosurgery (V.M.P.), Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada vitormpbr@hotmail.com.
authors.forename: V M
authors.identifier: http://orcid.org/0000-0002-6804-3985
authors.initials: VM
authors.lastname: Pereira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002545:Brain Ischemia / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002548:Cerebral Revascularization / Q000379:methods; D004285:Dogs; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015424:Reperfusion; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000601:surgery; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome