Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included. Primary outcome was futile EVT reperfusion (defined as 90-day modified Rankin scale of 5 or 6). Other outcomes of interest include acceptable outcomes (modified Rankin scale of 3 or less) and intracranial hemorrhage (ICH), and all-cause 90-day mortality. Outcomes for M1 patients were compared to M2 patients with multivariable logistic regression models accounting for potential confounders.Results173 patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT were identified. After multivariable adjustments, M2 patients had significantly higher odds of futile reperfusion (OR 5.48 [95%CI 1.91 to 15.7], p = 0.002), lower odds of acceptable outcomes (OR 0.33 [95%CI 0.12 to 0.89], p = 0.028), and higher odds of all-cause mortality (OR 4.90 [95%CI 1.65 to 14.5], p = 0.004). These findings suggest that EVT's efficacy for low-ASPECTS stroke patients may be diminished for patients with M2 occlusions. M2 occlusion was not significantly associated with ICH.ConclusionsAmong low-ASEPCTS stroke patients who underwent successful EVT, those with M2 occlusions had significantly higher odds of poor outcome compared to those with M1 occlusions.

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Journal
Interventional Neuroradiology
Published
2025-06-18
DOI
https://doi.org/10.1177/15910199251343283
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

Stacey Q Wolfe, Shakeel Chowdhry, Roberto Crosa, Hidetoshi Matsukawa et al.
Interventional Neuroradiology
Acute Ischemic Stroke Management
article

Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

Stacey Q Wolfe, Shakeel Chowdhry, Roberto Crosa, Hidetoshi Matsukawa, Pedro Navía, Joshua William Osbun, Amir Shaban, Richard Williamson, Fazeel Siddiqui, Ilko Maier, Brian M. Howard, David Altschul, Conor Cunningham, Alejandro M Spiotta, Ali M. Alaraj, Ramesh Grandhi, Mohamad Ezzeldin, Justin Robert Mascitelli, Adam Polifka, Waleed Brinjikji, Marco Colasurdo, Nitin Goyal, Pascal M. Jabbour, Ansaar Rai, Omar Tanweer, Ali Mostafa Alawieh, Huanwen Alvin Chen, Daniele Giuseppe Romano, Hugo Cuellar, Ergün Dağlıoğlu, Isabel Fragata, Charles Matouk, Marios‐Nikos Psychogios, Mark Moss, Joon-Tae Kim, Min Park, Robert M. Starke, Shinichi Yoshimura, Michael R Levitt, Peter Kan
article en

Abstract

BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included. Primary outcome was futile EVT reperfusion (defined as 90-day modified Rankin scale of 5 or 6). Other outcomes of interest include acceptable outcomes (modified Rankin scale of 3 or less) and intracranial hemorrhage (ICH), and all-cause 90-day mortality. Outcomes for M1 patients were compared to M2 patients with multivariable logistic regression models accounting for potential confounders.Results173 patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT were identified. After multivariable adjustments, M2 patients had significantly higher odds of futile reperfusion (OR 5.48 [95%CI 1.91 to 15.7], p = 0.002), lower odds of acceptable outcomes (OR 0.33 [95%CI 0.12 to 0.89], p = 0.028), and higher odds of all-cause mortality (OR 4.90 [95%CI 1.65 to 14.5], p = 0.004). These findings suggest that EVT's efficacy for low-ASPECTS stroke patients may be diminished for patients with M2 occlusions. M2 occlusion was not significantly associated with ICH.ConclusionsAmong low-ASEPCTS stroke patients who underwent successful EVT, those with M2 occlusions had significantly higher odds of poor outcome compared to those with M1 occlusions.

Interventional Neuroradiology
West Virginia University (US), University of Iowa (US), Atrium Health Wake Forest Baptist (US), Albert Einstein College of Medicine (US), Mayo Clinic (US), Montefiore Medical Center (US), NorthShore University HealthSystem (US), Hyogo Medical University (JP), Thomas Jefferson University (US), Emory University (US), Medical University of South Carolina (US), University of Tennessee Health Science Center (US), The University of Texas at San Antonio Health Science Center (US), Baylor College of Medicine (US), Georgetown University (US), University of Washington (US), Washington University in St. Louis (US), University of Utah (US), University of Michigan (US), Allegheny General Hospital (US), Hospital Universitario La Paz (ES), MedStar Georgetown University Hospital (US), University Hospital of Basel (CH), Yale University (US), University of Florida (US), University of Illinois Chicago (US), University of Chicago (US), Chonnam National University Hospital (KR), Central Baptist Hospital (US), University of Miami Health System (US), Semmes Murphey Foundation (US), Universitätsmedizin Göttingen (DE), Administracion de los Servicios de Salud del Estado (UY), Sağlık Bilimleri Üniversitesi (TR), Washington Regional Medical Center (US), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Lone Star College Kingwood (US), Oregon Health and Science University Hospital (US), University of Houston (US), University of Virginia (US), The University of Texas Medical Branch at Galveston (US), Louisiana State University Health Sciences Center Shreveport (US), Universidade Nova de Lisboa (PT)
National Science Foundation, Bristol-Myers Squibb, Pfizer, Medtronic, Neurosurgery Research and Education Foundation, Stryker, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Penumbra, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Siemens Healthineers, National Institutes of Health, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities
Good health and well-being
Openalex Percentile: Top 80%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
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