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

doi:10.1093/neuros/nyx060

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 journal › Article › peer-review

17 Scopus citations

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 language	English (US)
Pages (from-to)	795-802
Number of pages	8
Journal	Neurosurgery
Volume	81
Issue number	5
DOIs	https://doi.org/10.1093/neuros/nyx060
State	Published - Nov 1 2017
Externally published	Yes

Keywords

Acute stroke
Middle cerebral artery
Thrombectomy

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyx060

Cite this

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

Mokin, M, Primiani, CT, Ren, Z, Kan, P, Duckworth, E, Turner, RD, Turk, AS, Fargen, KM, Dabus, G, Linfante, I, Dumont, TM, Brasiliense, LBC, Shallwani, H, Snyder, KV, Siddiqui, AH & Levy, EI 2017, 'Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes', Neurosurgery, vol. 81, no. 5, pp. 795-802. https://doi.org/10.1093/neuros/nyx060

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title = "Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes",

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.",

keywords = "Acute stroke, Middle cerebral artery, Thrombectomy",

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

note = "Publisher Copyright: Copyright {\textcopyright} 2017 by the Congress of Neurological Surgeons",

year = "2017",

month = nov,

day = "1",

doi = "10.1093/neuros/nyx060",

language = "English (US)",

volume = "81",

pages = "795--802",

journal = "Neurosurgery",

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number = "5",

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TY - JOUR

T1 - Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes

T2 - Clinical and Procedural Predictors of Outcomes

AU - Mokin, Maxim

AU - Primiani, Christopher T.

AU - Ren, Zeguang

AU - Kan, Peter

AU - Duckworth, Edward

AU - Turner, Raymond D.

AU - Turk, Aquilla S.

AU - Fargen, Kyle M.

AU - Dabus, Guilherme

AU - Linfante, Italo

AU - Dumont, Travis M.

AU - Brasiliense, Leonardo B.C.

AU - Shallwani, Hussain

AU - Snyder, Kenneth V.

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

KW - Acute stroke

KW - Middle cerebral artery

KW - Thrombectomy

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U2 - 10.1093/neuros/nyx060

DO - 10.1093/neuros/nyx060

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AN - SCOPUS:85042142141

SN - 0148-396X

VL - 81

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JO - Neurosurgery

JF - Neurosurgery

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

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