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

被引：7

作者：

Bala, F. ^{[1
,2
,3
]}

Kim, B. J. ^{[4
,5
]}

Najm, M. ^{[1
,2
]}

Thornton, J. ^{[6
,8
]}

Fainardi, E. ^{[9
]}

Michel, P. ^{[10
,11
]}

Alpay, K. ^{[12
]}

Herlihy, D. ^{[6
]}

Goyal, M. ^{[1
,2
]}

Casetta, I. ^{[13
]}

Nannoni, S. ^{[10
,11
]}

Ylikotila, P. ^{[16
]}

Power, S. ^{[6
]}

Saia, V. ^{[14
]}

Hegarty, A. ^{[8
]}

Pracucci, G. ^{[15
]}

Rautio, R. ^{[12
]}

Ademola, A. ^{[17
]}

Demchuk, A. ^{[1
,2
]}

Mangiafico, S. ^{[18
]}

Boyle, K. ^{[7
]}

Hill, M. D. ^{[1
,2
,17
]}

Toni, D. ^{[19
]}

Murphy, S. ^{[20
,21
,22
]}

Menon, B. K. ^{[1
,2
,17
]}

Almekhlafi, M. A. ^{[1
,2
,17
]}

机构：

[1] Univ Calgary, Dept Clin Neurosci, Calgary Stroke Program, Calgary, AB, Canada

[2] Univ Calgary, Dept Radiol, Calgary Stroke Program, Calgary, AB, Canada

[3] Univ Hosp Tours, Diagnost & Intervent Neuroradiol Dept, Tours, France

[4] Seoul Natl Univ, Bundang Hosp, Dept Neurol, Seoul, South Korea

[5] Seoul Natl Univ, Bundang Hosp, Cerebrovasc Ctr, Seoul, South Korea

[6] Beaumont Hosp, Neuroradiol Dept, Dublin, Ireland

[7] Beaumont Hosp, Dept Geriatr & Stroke Med, Dublin, Ireland

[8] Royal Coll Surgeons Ireland, Dublin, Ireland

[9] Univ Florence, Dept Expt & Clin Biomed Sci, Neuroradiol Unit, Florence, Italy

[10] Lausanne Univ Hosp, Stroke Ctr, Neurol Serv, Lausanne, Switzerland

[11] Univ Lausanne, Lausanne, Switzerland

[12] Turku Univ Hosp, Dept Radiol, Turku, Finland

[13] Univ Ferrara, Clin Neurol, Ferrara, Italy

[14] Santa Corona Hosp, Stroke Unit, Pietra Ligure, Italy

[15] Careggi Univ Hosp, Stroke Unit, Florence, Italy

[16] Univ Turku, Turku Univ Hosp, Neuroctr, Turku, Finland

[17] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada

[18] Inst Hospitalizat & Healthcare Neuromed, Intervent Neuroradiol Unit, Pozzilli, Italy

[19] Sapienza Univ Hosp, Emergency Dept, Stroke Unit, Rome, Italy

[20] Mater Misericordiae Univ Hosp, Dept Geriatr & Stroke Med, Dublin, Ireland

[21] Royal Coll Surgeons Ireland, Sch Med, Dublin, Ireland

[22] Univ Coll Dublin, Sch Med, Dublin, Ireland

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2023年 / 44卷 / 04期

关键词：

ACUTE ISCHEMIC-STROKE; MIDDLE CEREBRAL-ARTERY; MECHANICAL THROMBECTOMY; MULTICENTER; SELECTION; EFFICACY; SAFETY;

D O I：

10.3174/ajnr.A7833

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND PURPOSE: 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 com-pared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset.MATERIALS AND METHODS: 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.RESULTS: 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 independ-ence 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).CONCLUSIONS: 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.

引用

页码：447 / 452

页数：6

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