Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes.
BACKGROUND
Patients with strokes from M2 segment middle cerebral artery (MCA) occlusion have been underrepresented in recent randomized trials of endovascular therapy.


OBJECTIVE
To better understand the clinical, imaging, and procedural predictors of successful recanalization and clinical outcomes in this population of patients.


METHODS
We performed a multicenter retrospective analysis of consecutive patients with acute MCA M2 segment occlusion who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics.


RESULTS
One hundred and seventeen patients were included in analysis (median admission National Institutes of Health stroke scale [NIHSS] score 15, mean age 67.0 ± 14.5, 42% females). Good clinical outcome at 3 months (modified Rankin scale [mRS] ≤ 2) was achieved in 56% of patients. Treatment beyond 6 h of symptoms onset (P = .69, OR 0.80, 95% CI 0.38-1.73) and age over 80 (P = .47, OR 0.65, 95% CI 0.25-1.70) were not predictive of poor outcome. NIHSS > 15 was a strong predictor of clinical outcome, based on mRS distribution at 3 months (P = .0085, OR 0.35, 95% CI 0.16-0.74). Direct aspiration and primary stent retriever thrombectomy approaches showed similar radiographic and clinical success rates.


CONCLUSIONS
Advanced age and time to treatment beyond 6 h from symptom onset were not predictive of clinical outcome with thrombectomy. NIHSS score above 15 was a strong predictor of outcome. Direct aspiration and primary stent retriever thrombectomy showed similar efficacy.
Department of Neurosurgery, University of South Florida, Tampa, Florida.
Maxim
M
Mokin
Department of Neurosurgery, University of South Florida, Tampa, Florida.
Christopher T
CT
Primiani
Department of Neurosurgery, University of South Florida, Tampa, Florida.
Zeguang
Z
Ren
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Peter
P
Kan
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Edward
E
Duckworth
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina.
Raymond D
RD
Turner
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina.
Aquilla S
AS
Turk
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina.
Kyle M
KM
Fargen
Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, Miami, Florida.
Guilherme
G
Dabus
Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, Miami, Florida.
Italo
I
Linfante
Department of Neurosurgery, University of Arizona, Tucson, Arizona.
Travis M
TM
Dumont
Department of Neurosurgery, University of Arizona, Tucson, Arizona.
Leonardo B C
LBC
Brasiliense
Department of Neurosurgery, University at Buffalo, Buffalo, New York.
Hussain
H
Shallwani
Department of Neurosurgery, University at Buffalo, Buffalo, New York.
Kenneth V
KV
Snyder
Department of Neurosurgery, University at Buffalo, Buffalo, New York.
Adnan H
AH
Siddiqui
Department of Neurosurgery, University at Buffalo, Buffalo, New York.
Elad I
EI
Levy
D000368:Aged; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
Acute stroke; Middle cerebral artery; Thrombectomy