Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review

被引：43

作者：

Chen, Ching-Jen ^{[1
]}

Wang, Connor ^{[1
]}

Buell, Thomas J. ^{[1
]}

Ding, Dale ^{[2
]}

Raper, Daniel M. ^{[1
]}

Ironside, Natasha ^{[3
]}

Paisan, Gabriella M. ^{[1
]}

Starke, Robert M. ^{[4
]}

Southerland, Andrew M. ^{[5
]}

Liu, Kenneth ^{[1
]}

Worrall, Bradford B. ^{[5
]}

机构：

[1] Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA 22903 USA

[2] Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA

[3] Auckland City Hosp, Dept Neurosurg, Auckland, New Zealand

[4] Univ Miami, Dept Neurol Surg, Miami, FL USA

[5] Univ Virginia Hlth Syst, Dept Neurol, Charlottesville, VA USA

来源：

WORLD NEUROSURGERY | 2017年 / 107卷

关键词：

Distal; Endovascular procedures; Ischemia; Middle cerebral artery; Review; Stroke; Thrombectomy; ACUTE ISCHEMIC-STROKE; STENT-RETRIEVER THROMBECTOMY; II TRIAL; MANAGEMENT; THERAPY; THROMBOLYSIS; CIRCULATION; ANGIOGRAPHY; OUTCOMES; SCORE;

D O I：

10.1016/j.wneu.2017.08.108

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

INTRODUCTION: The benefit of endovascular mechanical thrombectomy (EMT) for acute distal occlusions of the middle cerebral artery M2 segment is incompletely defined. The aim of this systematic review is to analyze the recent literature regarding EMT for acute M2 occlusions. - METHODS: We reviewed the literature to identify all studies of patients with acute M2 occlusions who underwent EMT that were published after January 1, 2015. Excellent and good outcomes were defined as modified Rankin Scale score of 0-1 and 0-2, respectively, at 3 months. Successful reperfusion was defined as modified Thrombolysis In Cerebral Infarction (mTICI) score of 2b-3. - RESULTS: Eight studies, comprising 630 EMT-treated patients with acute M2 occlusions, were included in the analysis. The median National Institute of Health Stroke Scale score ranged from 10 to 16, and the median Alberta Stroke Program Computed Tomography Score ranged from 9 to 10. Excellent and good outcomes at 3-month follow-up were observed in 40% and 62%, respectively, of patients with acute M2 occlusion who underwent EMT, with a mortality of 11%. Successful reperfusion was achieved in 78% of cases. Postprocedural intracerebral hemorrhage (ICH) occurred in 14% of patients, including a symptomatic ICH rate of 5%. CONCLUSIONS: EMT for acute M2 occlusion affords functional independence to most patients, with a modest rate of symptomatic ICH. However, compared with the natural history of distal MCA occlusions, the benefit of M2 thrombectomy using stent retriever or direct aspiration techniques remains unclear.

引用

页码：684 / 691

页数：8

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