Stephan A Munich1, Shelby L Hall, Marshall C Cress, Leonardo Rangel-Castilla, Kenneth V Snyder, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy. 1. *Department of Neurosurgery, ‡Department of Radiology, §Department of Neurology, School of Medicine and Biomedical Sciences, and ¶Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; ‖Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; #Jacobs Institute, Buffalo, New York.
Abstract
BACKGROUND: Occlusions of the M2 segment of the middle cerebral artery may cause significant clinical effects, especially when occurring in the dominant cerebral hemisphere, yet endovascular treatment of these lesions remains controversial. OBJECTIVE: To examine the safety and efficacy of endovascular treatment of M2 occlusions at our institution. METHODS: We retrospectively examined radiographic and clinical data of 53 patients presenting with M2 occlusions to our institution. RESULTS: Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 40 patients (76.9%). No symptomatic intracranial hemorrhage occurred. The mean National Institutes of Health Stroke Scale score at discharge was 6.4 (median, 5.5). In the 38 patients who had follow-up after discharge, the mean follow-up duration was 11.1 months (range, 0.5-36.5 months) and mean National Institutes of Health Stroke Scale score was 3.5 (median, 1). CONCLUSION: The results of our single-institution experience suggest that endovascular therapy for M2 occlusions is safe and effective. Additional evaluation with randomized, controlled studies is warranted. ABBREVIATIONS: ADAPT, direct aspiration first-pass techniqueECASS, European-Australasian Cooperative Acute Stroke StudyICH, intracranial hemorrhageIMS, Interventional Management of StrokeMERCI, Mechanical Embolus Removal in Cerebral IschemiamRS, modified Rankin ScaleNIHSS, National Institutes of Health Stroke ScalePROACT, Prolyse in Acute Cerebral ThromboembolismTICI, Thrombolysis in Cerebral Infarctiont-PA, tissue-type plasminogen activator.
BACKGROUND: Occlusions of the M2 segment of the middle cerebral artery may cause significant clinical effects, especially when occurring in the dominant cerebral hemisphere, yet endovascular treatment of these lesions remains controversial. OBJECTIVE: To examine the safety and efficacy of endovascular treatment of M2 occlusions at our institution. METHODS: We retrospectively examined radiographic and clinical data of 53 patients presenting with M2 occlusions to our institution. RESULTS: Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) was achieved in 40 patients (76.9%). No symptomatic intracranial hemorrhage occurred. The mean National Institutes of Health Stroke Scale score at discharge was 6.4 (median, 5.5). In the 38 patients who had follow-up after discharge, the mean follow-up duration was 11.1 months (range, 0.5-36.5 months) and mean National Institutes of Health Stroke Scale score was 3.5 (median, 1). CONCLUSION: The results of our single-institution experience suggest that endovascular therapy for M2 occlusions is safe and effective. Additional evaluation with randomized, controlled studies is warranted. ABBREVIATIONS: ADAPT, direct aspiration first-pass techniqueECASS, European-Australasian Cooperative Acute Stroke StudyICH, intracranial hemorrhageIMS, Interventional Management of StrokeMERCI, Mechanical Embolus Removal in Cerebral IschemiamRS, modified Rankin ScaleNIHSS, National Institutes of Health Stroke ScalePROACT, Prolyse in Acute Cerebral ThromboembolismTICI, Thrombolysis in Cerebral Infarctiont-PA, tissue-type plasminogen activator.