Vivien Lorena Ivan1, Christian Rubbert2, Julian Caspers2, John-Ih Lee3, Michael Gliem3, Sebastian Jander3, Bernd Turowski2, Marius Kaschner2. 1. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. vivien.ivan@med.uni-duesseldorf.de. 2. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. 3. Department of Neurology, Heinrich-Heine-University, Medical faculty, Düsseldorf, Germany.
Abstract
BACKGROUND: Endovascular treatment (EVT) is an established procedure in patients with acute ischemic stroke due to occlusion of the proximal M1-segment of middle cerebral artery. The assessment of distal thrombectomy in daily clinical routine has not yet been sufficiently evaluated. METHODS: Patients with M2-segment-occlusions treated by EVT in the local department (January 2012-December 2017) were included (n = 57, mean National-Institutes-of-Health-Stroke-Scale of 11, range 0-20). Patients were grouped according to localization of M2-occlusion (Cohort A (n = 14): central region only, B (n = 24): central region and involvement of frontal vessels, C (n = 19): parietal, occipital, and/or temporal vessels). Differences in proximal (M2-trunk, n = 34) and distal (M2-branches, n = 23) occlusions were also examined. Reperfusion (Thrombolysis-In-Cerebral-Infarction (TICI)), early clinical outcome at discharge (modified Rankin Scale (mRS)), and complications (hemorrhage, new emboli) were noted. RESULT: Successful reperfusion (TICI2b-3) was found in 49 patients (86.0%). Favorable early clinical outcome (mRS0-2) was achieved in n = 19 (37.7%). Compared to admission, mRS at discharge improved significantly (median (admission) 5 vs. median (discharge) 4, p < 0.001). Early clinical outcome was more favorable in patients with better reperfusion (TICI2b-3: mean mRS 3 ± 1.7 vs. TICI0-2a: mean mRS 4.4 ± 1.4, p = 0.037). Six (10.5%) patients suffered from symptomatic intracranial hemorrhage during treatment or hospitalization. Four patients died (7.0%). No significant differences in favorable clinical outcome (mRS ≤ 2: Cohort A 42.9%, B 50.0%, C 16.7%, p = 0.4; χ2-test) or periinterventional complications were found with regard to vessel involvement. CONCLUSION: EVT in patients with acute M2-occlusion is safe and leads to a significant clinical improvement at discharge. No significant differences in clinical outcome or complications were found with regard to the localization of the M2-occlusion.
BACKGROUND: Endovascular treatment (EVT) is an established procedure in patients with acute ischemic stroke due to occlusion of the proximal M1-segment of middle cerebral artery. The assessment of distal thrombectomy in daily clinical routine has not yet been sufficiently evaluated. METHODS:Patients with M2-segment-occlusions treated by EVT in the local department (January 2012-December 2017) were included (n = 57, mean National-Institutes-of-Health-Stroke-Scale of 11, range 0-20). Patients were grouped according to localization of M2-occlusion (Cohort A (n = 14): central region only, B (n = 24): central region and involvement of frontal vessels, C (n = 19): parietal, occipital, and/or temporal vessels). Differences in proximal (M2-trunk, n = 34) and distal (M2-branches, n = 23) occlusions were also examined. Reperfusion (Thrombolysis-In-Cerebral-Infarction (TICI)), early clinical outcome at discharge (modified Rankin Scale (mRS)), and complications (hemorrhage, new emboli) were noted. RESULT: Successful reperfusion (TICI2b-3) was found in 49 patients (86.0%). Favorable early clinical outcome (mRS0-2) was achieved in n = 19 (37.7%). Compared to admission, mRS at discharge improved significantly (median (admission) 5 vs. median (discharge) 4, p < 0.001). Early clinical outcome was more favorable in patients with better reperfusion (TICI2b-3: mean mRS 3 ± 1.7 vs. TICI0-2a: mean mRS 4.4 ± 1.4, p = 0.037). Six (10.5%) patients suffered from symptomatic intracranial hemorrhage during treatment or hospitalization. Four patientsdied (7.0%). No significant differences in favorable clinical outcome (mRS ≤ 2: Cohort A 42.9%, B 50.0%, C 16.7%, p = 0.4; χ2-test) or periinterventional complications were found with regard to vessel involvement. CONCLUSION:EVT in patients with acute M2-occlusion is safe and leads to a significant clinical improvement at discharge. No significant differences in clinical outcome or complications were found with regard to the localization of the M2-occlusion.
Authors: Ralph Rahme; Sharon D Yeatts; Todd A Abruzzo; Lincoln Jimenez; Liqiong Fan; Thomas A Tomsick; Andrew J Ringer; Anthony J Furlan; Joseph P Broderick; Pooja Khatri Journal: J Neurosurg Date: 2014-09-26 Impact factor: 5.115
Authors: Daniel Weiss; Christian Rubbert; Vivien L Ivan; John-Ih Lee; Michael Gliem; Sebastian Jander; Julian Caspers; Bernd Turowski; Marius G Kaschner Journal: Neuroradiol J Date: 2022-03-04