Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window

F Bala^{1

2}, B J Kim³, M Najm¹, J Thornton^{4

5}, E Fainardi⁶, P Michel⁷, K Alpay⁸, D Herlihy⁴, M Goyal¹, I Casetta⁹, S Nannoni⁷, P Ylikotila¹⁰, S Power⁴, V Saia¹¹, A Hegarty⁵, G Pracucci¹², R Rautio⁸, A Ademola¹³, A Demchuk¹, S Mangiafico¹⁴, K Boyle¹⁵, M D Hill^{1

13}, D Toni¹⁶, S Murphy^{17

18

19}, B K Menon^{1

13}, M A Almekhlafi^{20

13}; Selection of Late-window Stroke for Thrombectomy by Imaging Collateral Extent (SOLSTICE) Consortium

Affiliations

¹ From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada.
² Diagnostic and Interventional Neuroradiology Department (F.B.), University Hospital of Tours, Tours, France.
³ Department of Neurology and Cerebrovascular Center (B.J.K.), Seoul National University Bundang Hospital, Seoul, Republic of Korea.
⁴ Neuroradiology Department (J.T., D.H., S.P.).
⁵ Royal College of Surgeons in Ireland (J.T., A.H.), Dublin, Ireland.
⁶ Neuroradiology Unit (E.F.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
⁷ Stroke Center (P.M., S.N.), Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁸ Department of Radiology (K.A., R.R.), Turku University Hospital, Turku, Finland.
⁹ Clinica Neurologica (I.C.), University of Ferrara, Ferrara, Italy.
¹⁰ Neurocenter (P.Y.), Turku University Hospital, University of Turku, Turku, Finland.
¹¹ Stroke Unit (V.S.), Santa Corona Hospital, Pietra Ligure, Italy.
¹² Stroke Unit (G.P.), Careggi University Hospital, Florence, Italy.
¹³ Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada.
¹⁴ Interventional Neuroradiology Unit (S. Mangiafico), Institute for Hospitalization and Healthcare Neuromed, Pozzilli, Italy.
¹⁵ Department of Geriatric and Stroke Medicine (K.B.), Beaumont Hospital, Dublin, Ireland.
¹⁶ Emergency Department (D.T.), Stroke Unit, Sapienza University Hospital, Rome, Italy.
¹⁷ Department of Geriatric and Stroke Medicine (S. Murphy), The Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁸ School of Medicine (S. Murphy), Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁹ School of Medicine (S. Murphy), University College Dublin, Dublin, Ireland.
²⁰ From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada mohammed.almekhlafi1@ucalgary.ca.

PMID: 36958801
PMCID: PMC10084904
DOI: 10.3174/ajnr.A7833

Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window

F Bala et al. AJNR Am J Neuroradiol. 2023 Apr.

. 2023 Apr;44(4):447-452.

doi: 10.3174/ajnr.A7833. Epub 2023 Mar 23.

Authors

Affiliations

¹ From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada.
² Diagnostic and Interventional Neuroradiology Department (F.B.), University Hospital of Tours, Tours, France.
³ Department of Neurology and Cerebrovascular Center (B.J.K.), Seoul National University Bundang Hospital, Seoul, Republic of Korea.
⁴ Neuroradiology Department (J.T., D.H., S.P.).
⁵ Royal College of Surgeons in Ireland (J.T., A.H.), Dublin, Ireland.
⁶ Neuroradiology Unit (E.F.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
⁷ Stroke Center (P.M., S.N.), Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁸ Department of Radiology (K.A., R.R.), Turku University Hospital, Turku, Finland.
⁹ Clinica Neurologica (I.C.), University of Ferrara, Ferrara, Italy.
¹⁰ Neurocenter (P.Y.), Turku University Hospital, University of Turku, Turku, Finland.
¹¹ Stroke Unit (V.S.), Santa Corona Hospital, Pietra Ligure, Italy.
¹² Stroke Unit (G.P.), Careggi University Hospital, Florence, Italy.
¹³ Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada.
¹⁴ Interventional Neuroradiology Unit (S. Mangiafico), Institute for Hospitalization and Healthcare Neuromed, Pozzilli, Italy.
¹⁵ Department of Geriatric and Stroke Medicine (K.B.), Beaumont Hospital, Dublin, Ireland.
¹⁶ Emergency Department (D.T.), Stroke Unit, Sapienza University Hospital, Rome, Italy.
¹⁷ Department of Geriatric and Stroke Medicine (S. Murphy), The Mater Misericordiae University Hospital, Dublin, Ireland.
¹⁸ School of Medicine (S. Murphy), Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁹ School of Medicine (S. Murphy), University College Dublin, Dublin, Ireland.
²⁰ From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada mohammed.almekhlafi1@ucalgary.ca.

PMID: 36958801
PMCID: PMC10084904
DOI: 10.3174/ajnr.A7833

Abstract

Background and purpose: Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset.

Materials and methods: Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6-24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b-3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion.

Results: Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25-3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, P = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11-7.29).

Conclusions: In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.

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Figures

**FIG 1.**
Study flow chart for SOLSTICE. The *asterisk* indicates that 5 patients did not have 90-day follow-up data.

**FIG 2.**
mRS distribution at 90 days in patients with M1 and M2 occlusion in this study versus patients with M2 occlusion treated with endovascular thrombectomy in the HERMES collaboration.

See this image and copyright information in PMC

References

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Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window

Affiliations

Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window

Authors

Affiliations

Abstract

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical