. 2024 Jul 18;6(1):36.

doi: 10.1186/s42466-024-00330-7.

Endovascular treatment of primary M3 occlusion stroke in clinical practice: analysis of the German Stroke Registry

Niklas M Beckonert^#^{1

2}, Johannes M Weller^#³, Anna C Alegiani⁴, Tobias Boeckh-Behrens⁵, Milani Deb-Chatterji⁶, Gerhard F Hamann⁷, Lars U Krause⁸, Nils C Lehnen⁹, Louisa Nitsch³, Sven Poli¹⁰, Christian Riedel¹¹, Steffen Tiedt¹², Sarah Zweynert¹³, Gabor C Petzold^{3

14}, Franziska Dorn⁹, Felix J Bode³; GSR-ET investigators

Collaborators, Affiliations

Collaborators

GSR-ET investigators:
J Berrouschot, G Bohner, J Borggrefe, A Bormann, M Braun, B Eckert, U Ernemann, M S Ernst, J Fiehler, C Gerloff, K Gröschel, J Hattingen, K H Henn, F Keil, L Kellert, C Kraemer, J Liman, A Ludolph, R Muehl-Benninghaus, O Nikoubashman, C Nolte, M Petersen, A Reich, J Röther, J H Schäfer, M Schell, P Schellinger, E Siebert, F Stögbauer, G Thomalla, C Trumm, T Uphaus, S Wunderlich

Affiliations

¹ Department of Vascular Neurology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany. Niklas.beckonert@ukbonn.de.
² Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. Niklas.beckonert@ukbonn.de.
³ Department of Vascular Neurology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
⁴ Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany.
⁵ Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany.
⁶ Department of Neurology, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany.
⁷ Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany.
⁸ Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany.
⁹ Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
¹⁰ Department of Vascular Neurology, Eberhard-Karls University, Tuebingen, Germany.
¹¹ Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
¹² Institute for Stroke and Dementia Research, Klinikum Der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.
¹³ Department of Neurology, University Hospital Berlin Charité, Berlin, Germany.
¹⁴ Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.

^# Contributed equally.

PMID: 39020409
PMCID: PMC11256396
DOI: 10.1186/s42466-024-00330-7

Endovascular treatment of primary M3 occlusion stroke in clinical practice: analysis of the German Stroke Registry

Niklas M Beckonert et al. Neurol Res Pract. 2024.

. 2024 Jul 18;6(1):36.

doi: 10.1186/s42466-024-00330-7.

Authors

Collaborators

GSR-ET investigators:
J Berrouschot, G Bohner, J Borggrefe, A Bormann, M Braun, B Eckert, U Ernemann, M S Ernst, J Fiehler, C Gerloff, K Gröschel, J Hattingen, K H Henn, F Keil, L Kellert, C Kraemer, J Liman, A Ludolph, R Muehl-Benninghaus, O Nikoubashman, C Nolte, M Petersen, A Reich, J Röther, J H Schäfer, M Schell, P Schellinger, E Siebert, F Stögbauer, G Thomalla, C Trumm, T Uphaus, S Wunderlich

Affiliations

¹ Department of Vascular Neurology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany. Niklas.beckonert@ukbonn.de.
² Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. Niklas.beckonert@ukbonn.de.
³ Department of Vascular Neurology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
⁴ Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany.
⁵ Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany.
⁶ Department of Neurology, University Hospital Schleswig Holstein Campus Kiel, Kiel, Germany.
⁷ Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany.
⁸ Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany.
⁹ Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
¹⁰ Department of Vascular Neurology, Eberhard-Karls University, Tuebingen, Germany.
¹¹ Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
¹² Institute for Stroke and Dementia Research, Klinikum Der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.
¹³ Department of Neurology, University Hospital Berlin Charité, Berlin, Germany.
¹⁴ Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.

^# Contributed equally.

PMID: 39020409
PMCID: PMC11256396
DOI: 10.1186/s42466-024-00330-7

Abstract

Background: Endovascular treatment (ET) options for acute stroke due to distal middle cerebral artery occlusions are rapidly evolving, but data on outcome and safety are sparse. We therefore performed an analysis of patients undergoing ET for primary M3 occlusions in routine clinical practice in a nationwide registry.

Methods: Patients enrolled between 01/20 and 12/21 in the prospective, multicenter German Stroke Registry-Endovascular Treatment (GSR-ET) were screened for mechanical thrombectomy performed for primary M3 occlusion. We analyzed neurological deficit as measured by the National Institute of Health Stroke Scale (NIHSS), symptomatic intracranial hemorrhage (sICH), thrombectomy technique, successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3) and functional outcome as measured by the modified Rankin Scale (mRS) at discharge and 90 days.

Results: Out of 5574 patients, 11 patients (0.2%, median age 80 years, 54.5% female) underwent ET for primary M3 occlusion. All patients had pre-admission mRS ≤ 1, median NIHSS on admission was 8, and successful reperfusion was achieved in 6/11 patients (54.5%). While no vasospasm, dissection or perforation was reported, symptomatic intracranial hemorrhage occurred in 2 patients (18.2%). Favorable outcome (mRS ≤ 2) was achieved in 6/11 patients (54.5%) at 90-day follow-up.

Conclusions: ET for primary M3 occlusions is rarely performed. While technically feasible, the procedure's potential benefits must be carefully weighed against its associated risks, including clinically relevant complications. Caution and further research is needed to optimize patient selection for this intervention.

Trial registration: GSR-ET; ClinicalTrials.gov Identifier: NCT03356392; Trial Registration Date: 11/29/2017.

Keywords: Clinical outcome; Endovascular treatment; MeVo; Mechanical thrombectomy; Stroke.

PubMed Disclaimer

Conflict of interest statement

NMB received travel grants from Sanofi and Viatris. FD is a consultant/proctor for Cerenovus/Johnson&Johnson, Balt, Cerus Endovascular and Phenox. She received speaker's honoraria from Acandis, Stryker, Cerenovus/Johnson&Johnson, Asahi and research support from Cerenovus/Johnson&Johnson. MDC reports grants from the Werner Otto Stiftung outside the submitted the work. All other authors report no conflicting interests.

Figures

**Fig. 1**
Endovascular treatment for primary M3 occlusion stroke. Initial run (A (PA), B (lateral): arterial, C (PA), D (lateral): parenchymal phase) demonstrates M3-occlusion (➔) with parietal perfusion deficit and full reperfusion of the branch ( ➔➔) after stent retriever thrombectomy (E, F)

See this image and copyright information in PMC

References

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Endovascular treatment of primary M3 occlusion stroke in clinical practice: analysis of the German Stroke Registry

Collaborators

Affiliations

Endovascular treatment of primary M3 occlusion stroke in clinical practice: analysis of the German Stroke Registry

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Medical