Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes

Maxim Mokin, Christopher T. Primiani, Zeguang Ren, Peter Kan, Edward Duckworth, Raymond D. Turner, Aquilla S. Turk, Kyle M. Fargen, Guilherme Dabus, Italo Linfante, Travis M. Dumont, Leonardo B.C. Brasiliense, Hussain Shallwani, Kenneth V. Snyder, Adnan H. Siddiqui, Elad I. Levy

Research output: Contribution to journalArticle

Abstract

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.

CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)795-802
Number of pages8
JournalNeurosurgery
Volume81
Issue number5
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Keywords

  • Acute stroke
  • Middle cerebral artery
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Mokin, M., Primiani, C. T., Ren, Z., Kan, P., Duckworth, E., Turner, R. D., Turk, A. S., Fargen, K. M., Dabus, G., Linfante, I., Dumont, T. M., Brasiliense, L. B. C., Shallwani, H., Snyder, K. V., Siddiqui, A. H., & Levy, E. I. (2017). Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes. Neurosurgery, 81(5), 795-802. https://doi.org/10.1093/neuros/nyx060