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

Ching Jen Chen, Connor Wang, Thomas J. Buell, Dale Ding, Daniel M. Raper, Natasha Ironside, Gabriella M. Paisan, Robert M. Starke, Andrew M. Southerland, Kenneth Liu, Bradford B. Worrall

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)684-691
Number of pages8
JournalWorld neurosurgery
Volume107
DOIs
StatePublished - Nov 2017

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Thrombectomy
Middle Cerebral Artery
Cerebral Hemorrhage
Reperfusion
Stroke
Alberta
Middle Cerebral Artery Infarction
Cerebral Infarction
National Institutes of Health (U.S.)
Natural History
Stents
Tomography
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Chen, C. J., Wang, C., Buell, T. J., Ding, D., Raper, D. M., Ironside, N., ... Worrall, B. B. (2017). Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review. World neurosurgery, 107, 684-691. https://doi.org/10.1016/j.wneu.2017.08.108
Chen, Ching Jen ; Wang, Connor ; Buell, Thomas J. ; Ding, Dale ; Raper, Daniel M. ; Ironside, Natasha ; Paisan, Gabriella M. ; Starke, Robert M. ; Southerland, Andrew M. ; Liu, Kenneth ; Worrall, Bradford B. / Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion : A Systematic Review. In: World neurosurgery. 2017 ; Vol. 107. pp. 684-691.
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title = "Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review",
abstract = "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.",
author = "Chen, {Ching Jen} and Connor Wang and Buell, {Thomas J.} and Dale Ding and Raper, {Daniel M.} and Natasha Ironside and Paisan, {Gabriella M.} and Starke, {Robert M.} and Southerland, {Andrew M.} and Kenneth Liu and Worrall, {Bradford B.}",
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Chen, CJ, Wang, C, Buell, TJ, Ding, D, Raper, DM, Ironside, N, Paisan, GM, Starke, RM, Southerland, AM, Liu, K & Worrall, BB 2017, 'Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion: A Systematic Review', World neurosurgery, vol. 107, pp. 684-691. https://doi.org/10.1016/j.wneu.2017.08.108

Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion : A Systematic Review. / Chen, Ching Jen; Wang, Connor; Buell, Thomas J.; Ding, Dale; Raper, Daniel M.; Ironside, Natasha; Paisan, Gabriella M.; Starke, Robert M.; Southerland, Andrew M.; Liu, Kenneth; Worrall, Bradford B.

In: World neurosurgery, Vol. 107, 11.2017, p. 684-691.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Endovascular Mechanical Thrombectomy for Acute Middle Cerebral Artery M2 Segment Occlusion

T2 - A Systematic Review

AU - Chen, Ching Jen

AU - Wang, Connor

AU - Buell, Thomas J.

AU - Ding, Dale

AU - Raper, Daniel M.

AU - Ironside, Natasha

AU - Paisan, Gabriella M.

AU - Starke, Robert M.

AU - Southerland, Andrew M.

AU - Liu, Kenneth

AU - Worrall, Bradford B.

PY - 2017/11

Y1 - 2017/11

N2 - 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.

AB - 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.

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