title: Occlusion Location of Middle Cerebral Artery Stroke and Outcome after Endovascular Treatment.
abstract: BACKGROUND
  The aim of this study was to analyze the influence of the location of middle cerebral artery (MCA) occlusion on recanalization, complications and outcome after endovascular therapy.
  
  
  METHODS
  Four-hundred sixty-four patients with acute MCA occlusions were treated with endovascular therapy.
  
  
  RESULTS
  Two-hundred ninety-three patients had M1 occlusions, 116 had M2, and 55 had M3/4 occlusions. Partial or complete recanalization was more frequently achieved in M1 (76.8%) than in M2 (59.1%) or M3/4 (47.3%, p < 0.001) occlusions, but favorable outcome (modified Rankin Scale 0-2) was less frequent in M1 (50.9%) than M2 (63.7%) or M3/4 (72.7%, p = 0.018) occlusions. Symptomatic intracerebral hemorrhage (ICH) did not differ between occlusion sites, but asymptomatic ICH was more common in M1 (22.6%) than in M2 occlusions (8.6%, p = 0.003). Recanalization was associated with favorable outcome in M1 (p < 0.001) and proximal M2 (p = 0.003) but not in distal M2 or M3/4 occlusions.
  
  
  CONCLUSIONS
  Recanalization with endovascular therapy was more frequently achieved in patients with proximal than distal MCA occlusions, but recanalization was associated with favorable outcome only in M1 and proximal M2 occlusions. Outcome was better with distal than proximal occlusions. This study shows that recanalization can be used as a surrogate marker for clinical outcome only in patients with proximal occlusions.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Slezak
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Rudolf
authors.initials: R
authors.lastname: Lüdi
authors.forename: Oliver
authors.initials: O
authors.lastname: Findling
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Mirjam Rachel
authors.initials: MR
authors.lastname: Heldner
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome