Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window.

Details

Serval ID
serval:BIB_3765A6E4CDF8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window.
Journal
AJNR. American journal of neuroradiology
Author(s)
Bala F., Kim B.J., Najm M., Thornton J., Fainardi E., Michel P., Alpay K., Herlihy D., Goyal M., Casetta I., Nannoni S., Ylikotila P., Power S., Saia V., Hegarty A., Pracucci G., Rautio R., Ademola A., Demchuk A., Mangiafico S., Boyle K., Hill M.D., Toni D., Murphy S., Menon B.K., Almekhlafi M.A.
Working group(s)
Selection of Late-window Stroke for Thrombectomy by Imaging Collateral Extent (SOLSTICE) Consortium
ISSN
1936-959X (Electronic)
ISSN-L
0195-6108
Publication state
Published
Issued date
04/2023
Peer-reviewed
Oui
Volume
44
Number
4
Pages
447-452
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset.
Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6-24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b-3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion.
Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25-3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, P = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11-7.29).
In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.
Keywords
Humans, Treatment Outcome, Stroke/etiology, Thrombectomy/methods, Intracranial Hemorrhages/surgery, Intracranial Hemorrhages/etiology, Endovascular Procedures/methods, Brain Ischemia/etiology, Retrospective Studies
Pubmed
Web of science
Create date
03/04/2023 15:39
Last modification date
03/06/2023 6:51
Usage data