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01-11-2020 | Stroke | Original Article

Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement

Authors: Vivien Lorena Ivan, Christian Rubbert, Julian Caspers, John-Ih Lee, Michael Gliem, Sebastian Jander, Bernd Turowski, Marius Kaschner

Published in: Neurological Sciences | Issue 11/2020

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 (M2-branches, 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.

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Title: Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement
Authors: Vivien Lorena Ivan
Christian Rubbert
Julian Caspers
John-Ih Lee
Michael Gliem
Sebastian Jander
Bernd Turowski
Marius Kaschner
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Stroke
Thrombectomy
Published in: Neurological Sciences / Issue 11/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04430-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mechanical thrombectomy in acute middle cerebral artery M2 segment occlusion with regard to vessel involvement

Abstract

Background

Methods

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Result

Conclusion

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