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. 2022 Aug 8;11(15):4619.
doi: 10.3390/jcm11154619.

Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)

Moriz Herzberg  1   2 , Franziska Dorn  3 , Christoph Trumm  1 , Lars Kellert  4 , Steffen Tiedt  4   5 , Katharina Feil  4   6 , Clemens Küpper  4 , Frank Wollenweber  7 , Thomas Liebig  1 , Hanna Zimmermann  1
Affiliations

Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)

Moriz Herzberg et al. J Clin Med. .

Abstract

There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0−2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65−82) and 77 (CI 66−83) years, respectively. Except for baseline NIHSS (15 (CI 10−18) vs. 11 (CI 6−16), p < 0.001) and ASPECTS (9 (CI 7−10) vs. 9 (CI 8−10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7−42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2−8) vs. 2 (CI 2−7)/(CI 2−2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome.

Keywords: M2; aspiration; distal occlusion; endovascular therapy; mechanical thrombectomy; outcome; stent retriever.

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Conflict of interest statement

Moriz Herzberg declares no conflict of interest. Franziska Dorn declares no conflict of interest. Christoph Trumm declares no conflict of interest. Steffen Tiedt declares no conflict of interest. Hanna Zimmermann declares no conflict of interest. Clemens Küpper declares no conflict of interest. Frank Wollenweber declares no conflict of interest. Lars Kellert has received funding for travel or speaker honoraria from Bayer Vital, Boehringer Ingelheim, Bristol-Meyer-Squibb, Daiichi Sanky, and Pfizer and funding from a research project from Boehringer Ingelheim outside of this study. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Katharina Feil has received funding from a research project from Boehringer Ingelheim outside of this study (Lexi Study). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Thomas Liebig consults for Stryker Neurovascular GmbH and has received speaker honoraria from Pfizer, Covidien, Phenox, and Microvention outside this study. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of patient selection and exclusion criteria. GSR: German stroke registry; MCA: middle cerebral artery; mRS: modified Rankin Scale; NIHSS: National Institutes of Health Stroke Scale. ‡ multiple missing data within one excluded dataset possible.
Figure 2
Figure 2
Flowchart of patient selection and exclusion criteria. Distribution of scores on the modified Rankin Scale (mRS) at 90 days. Shown is the shift in outcome within the study population (M1: n = 2689; M2: n = 1115). The numbers represent the percentage (rounded to first digit) of patients for a given outcome and group.
See this image and copyright information in PMC

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