Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis

被引：26

作者：

Alexandre, Andrea M. ^{[1
]}

Colo, Francesca ^{[2
]}

Brunetti, Valerio ^{[3
]}

Valente, Iacopo ^{[1
]}

Frisullo, Giovanni ^{[3
]}

Pedicelli, Alessandro ^{[1
]}

Scarcia, Luca ^{[2
]}

Rollo, Claudia ^{[2
]}

Falcou, Anne ^{[4
]}

Milonia, Luca ^{[5
]}

Andrighetti, Marco ^{[4
]}

Piano, Mariangela ^{[6
]}

Macera, Antonio ^{[6
]}

Commodaro, Christian ^{[7
]}

Ruggiero, Maria ^{[7
]}

Da Ros, Valerio ^{[8
]}

Bellini, Luigi ^{[8
]}

Lazzarotti, Guido A. ^{[9
]}

Cosottini, Mirco ^{[9
]}

Caragliano, Armando A. ^{[10
]}

Vinci, Sergio L. ^{[10
]}

Gabrieli, Joseph D. ^{[11
]}

Causin, Francesco ^{[11
]}

Panni, Pietro ^{[12
]}

Roveri, Luisa ^{[13
]}

Limbucci, Nicola ^{[14
]}

Arba, Francesco ^{[15
]}

Pileggi, Marco ^{[16
]}

Bianco, Giovanni ^{[17
]}

Romano, Daniele G. ^{[18
]}

Diana, Francesco ^{[18
]}

Semeraro, Vittorio ^{[19
]}

Burdi, Nicola ^{[19
]}

Ganimede, Maria P. ^{[20
]}

Lozupone, Emilio ^{[21
]}

Fasano, Antonio ^{[22
]}

Lafe, Elvis ^{[23
]}

Cavallini, Anna ^{[24
]}

Russo, Riccardo ^{[25
]}

Bergui, Mauro ^{[25
]}

Calabresi, Paolo ^{[2
,3
]}

Della Marca, Giacomo ^{[2
,3
]}

Broccolini, Aldobrando ^{[2
,3
]}

机构：

[1] Fdn Policlin Univ A Gemelli IRCCS, Neuroradiol Unit, Rome, Italy

[2] Catholic Univ, Sch Med, Rome, Italy

[3] Fdn Policlin Univ A Gemelli IRCCS, Neurol Unit, Rome, Italy

[4] Univ Hosp Policlin Umberto I, Stroke Unit, Rome, Italy

[5] Univ Hosp Policlin Umberto I, Intervent Neuroradiol, Rome, Italy

[6] ASST Grande Osped Metropolitano Niguarda, Neuroradiol Unit, Milan, Italy

[7] AUSL Romagna, Neuroradiol Unit, Cesena, Italy

[8] Univ Hosp Rome Tor Vergata, Dept Biomed & Prevent, Rome, Italy

[9] Azienda Osped Univ Pisana AOUP, Neuroradiol Unit, Pisa, Italy

[10] AOU Policlin G Martino, Neuroradiol Unit, Messina, Italy

[11] Univ Padua Polyclin, Neuroradiol Unit, Padia, Italy

[12] IRCCS San Raffaele Univ Hosp, Intervent Neuroradiol Unit, Milan, Italy

[13] IRCCS San Raffaele Univ Hosp, Neurol Unit, Milan, Italy

[14] AOU Careggi, Intervent Neurovasc Unit, Florence, Italy

[15] AOU Careggi, Stroke Unit, Florence, Italy

[16] Neuroctr Southern Switzerland EOC, Neuroradiol Unit, Lugano, Switzerland

[17] Neuroctr Southern Switzerland EOC, Stroke Ctr, Lugano, Switzerland

[18] AOU S Giovanni Dio & Ruggi Aragona, Neuroradiol Unit, Salerno, Italy

[19] SS Annunziata Hosp, Intervent Radiol Unit, Taranto, Italy

[20] SS Annunziata Hosp, Neuroradiol Unit, Taranto, Italy

[21] Vito Fazzi Hosp, Neuroradiol Unit, Lecce, Italy

[22] Vito Fazzi Hosp, Neurol Unit, Lecce, Italy

[23] IRCCS Policlin San Matteo, Neuroradiol Unit, Pavia, Italy

[24] IRCCS Fdn Mondino, Cerebrovasc Dis Unit, Pavia, Italy

[25] Azienda Osped Citta Salute & Sci, Neuroradiol Unit, Turin, Italy

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / E2期

关键词：

stroke; thrombectomy; thrombolysis; ACUTE ISCHEMIC-STROKE; LARGE-VESSEL OCCLUSIONS; MIDDLE CEREBRAL-ARTERY; NEUROLOGICAL DETERIORATION; SCORE; PERFUSION; THERAPY; SEGMENT;

D O I：

10.1136/jnis-2022-019557

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background The purpose of this study was to evaluate the effectiveness of mechanical thrombectomy (MT) in patients with isolated M2 occlusion and minor symptoms and identify possible baseline predictors of clinical outcome. Methods The databases of 16 high-volume stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score <= 5 who received either early MT (eMT) or best medical management (BMM) with the possibility of rescue MT (rMT) on early neurological worsening. Because our patients were not randomized, we used propensity score matching (PSM) to estimate the treatment effect of eMT compared with the BMM/rMT. The primary clinical outcome measure was a 90-day modified Rankin Scale score of 0-1. Results 388 patients were initially selected and, after PSM, 100 pairs of patients receiving eMT or BMM/rMT were available for analysis. We found no significant differences in clinical outcome and in safety measures between patients receiving eMT or BMM/rMT. Similar results were also observed after comparison between eMT and rMT. Concerning baseline predicting factors of outcome, the involvement of the M2 inferior branch was associated with a favorable outcome. Conclusion Our multicenter retrospective analysis has shown no benefit of eMT in minor stroke patients with isolated M2 occlusion over a more conservative therapeutic approach. Although our results must be viewed with caution, in these patients it appears reasonable to consider BMM as the first option and rMT in the presence of early neurological deterioration.

引用

页码：E198 / E203

页数：6

共 30 条

[1] Some Methods of Propensity-Score Matching had Superior Performance to Others: Results of an Empirical Investigation and Monte Carlo simulations [J].

Austin, Peter C. .

BIOMETRICAL JOURNAL, 2009, 51 (01) :171-184

[2] Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy [J].

Barber, PA ;

Demchuk, AM ;

Zhang, JJ ;

Buchan, AM .

LANCET, 2000, 355 (9216) :1670-1674

[3] European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke [J].

Berge, Eivind ;

Whiteley, William ;

Audebert, Heinrich ;

Marchis, Gian Marco De ;

Fonseca, Ana Catarina ;

Padiglioni, Chiara ;

Ossa, Natalia Perez de la ;

Strbian, Daniel ;

Tsivgoulis, Georgios ;

Turc, Guillaume .

EUROPEAN STROKE JOURNAL, 2021, 6 (01) :I-LXII

[4] Caution; Confusion Ahead... [J].

Capocci, R. ;

Shotar, E. ;

Sourour, N. -A. ;

Haffaf, I. ;

Bartolini, B. ;

Clarencon, F. .

AMERICAN JOURNAL OF NEURORADIOLOGY, 2017, 38 (06) :E40-E43

[5] Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke [J].

Compagne, Kars C. J. ;

van der Sluijs, Pieter M. ;

van den Wijngaard, Ido R. ;

Roozenbeek, Bob ;

Mulder, Maxim J. H. L. ;

van Zwam, Wim H. ;

Emmer, Bart J. ;

Majoie, Charles B. L. M. ;

Yoo, Albert J. ;

Nijeholt, Geert J. Lycklama A. ;

Lingsma, Hester F. ;

Dippel, Diederik W. J. ;

van der Lugt, Aad ;

van Es, Adriaan C. G. M. ;

Roos, Yvo B. W. E. M. ;

van Oostenbrugge, Robert J. ;

Boiten, Jelis ;

Vos, Jan Albert ;

Jansen, Ivo G. H. ;

Goldhoorn, Robert-Jan B. ;

Schonewille, Wouter J. ;

Coutinho, Jonathan M. ;

Wermer, Marieke J. H. ;

van Walderveen, Marianne A. A. ;

Staals, Julie ;

Hofmeijer, Jeannette ;

Martens, Jasper M. ;

de Bruijn, Sebastiaan F. ;

van Dijk, Lukas C. ;

van der Worp, H. Bart ;

Lo, Rob H. ;

van Dijk, Ewoud J. ;

Boogaarts, Hieronymus D. ;

de Kort, Paul L. M. ;

Peluso, Jo J. P. ;

van den Berg, Jan S. P. ;

van Hasselt, Boudewijn A. A. M. ;

Aerden, Leo A. M. ;

Dallinga, Rene J. ;

Uyttenboogaart, Maarten ;

Eshghi, Omid ;

Schreuder, Tobien H. C. M. L. ;

Heijboer, Roel J. J. ;

Keizer, Koos ;

Yo, Lonneke S. F. ;

den Hertog, Heleen M. ;

Sturm, Emiel J. C. ;

Sprengers, Marieke E. S. ;

Jenniskens, Sjoerd F. M. ;

van den Berg, Rene .

STROKE, 2019, 50 (02) :419-427

[6] Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study [J].

de Havenon, Adam ;

Narata, Ana Paula ;

Amelot, Aymeric ;

Saver, Jeffrey L. ;

Bozorgchami, Hormozd ;

Mattle, Heinrich Paul ;

Ribo, Marc ;

Andersson, Tommy ;

Zaidat, Osama O. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2021, 13 (09) :779-783

[7] RECOMBINANT TISSUE PLASMINOGEN-ACTIVATOR IN ACUTE THROMBOTIC AND EMBOLIC STROKE [J].

DELZOPPO, GJ ;

POECK, K ;

PESSIN, MS ;

WOLPERT, SM ;

FURLAN, AJ ;

FERBERT, A ;

ALBERTS, MJ ;

ZIVIN, JA ;

WECHSLER, L ;

BUSSE, O ;

GREENLEE, R ;

BRASS, L ;

MOHR, JP ;

FELDMANN, E ;

HACKE, W ;

KASE, CS ;

BILLER, J ;

GRESS, D ;

OTIS, SM .

ANNALS OF NEUROLOGY, 1992, 32 (01) :78-86

[8] Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits [J].

Dobrocky, Tomas ;

Piechowiak, Eike, I ;

Volbers, Bastian ;

Slavova, Nedelina ;

Kaesmacher, Johannes ;

Meinel, Thomas R. ;

Arnold, Marcel ;

Fischer, Urs ;

Jung, Simon ;

Gralla, Jan ;

Mordasini, Pasquale ;

Heldner, Mirjam R. .

STROKE, 2021, 52 (03) :802-810

[9] Scoring flow restoration in cerebral angiograms after endovascular revascularization in acute ischemic stroke patients [J].

Gerber, Johannes C. ;

Miaux, Yves J. ;

von Kummer, Ruediger .

NEURORADIOLOGY, 2015, 57 (03) :227-240

[10] What constitutes the M1 segment of the middle cerebral artery? [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

Krings, Timo ;

Patil, Shivanand ;

Qazi, Emmad ;

McTaggart, Ryan A. ;

Almekhlafi, Mohammed A. ;

Jehan, Reza ;

Saver, Jeffrey ;

Jayaraman, Mahesh V. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2016, 8 (12) :1273-1277

← 1 2 3 →