Kim Chul Ho, Kim Sung-Eun, Jeon Jin Pyeong
Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea.
Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea.
J Korean Neurosurg Soc. 2019 Mar;62(2):193-200. doi: 10.3340/jkns.2017.0299. Epub 2019 Feb 27.
Endovascular treatment (EVT) outcomes for acute M2 segment of middle cerebral artery occlusion remains unclear because most results are obtained from patients with large artery occlusion in the anterior circulation. The objective of this study was to assess procedural outcomes for acute M2 occlusion and compare outcomes according to thrombus location (M1 vs. M2).
A systematic review was performed for online literature published from January 2004 to December 2016. Primary outcome was successful recanalization rate and symptomatic intracranial hemorrhage (S-ICH) after the procedure. A fixed effect model was used if heterogeneity was less than 50%.
Eight articles were included. EVT showed successful recanalization rate of 69.1% (95% confidence interval [CI], 54.9-80.4%) and S-ICH rate of 6.1% (95% CI, 4.5-8.3%). The rates of good clinical outcome at 3 months and mortality were 59.4% (95% CI, 49.9-68.2%) and 14.9% (95% CI, 11.4-19.3%), respectively. According to thrombus location (M1 vs. M2), successful recanalization (odds ratio [OR], 1.539; 95% CI, 0.293-8.092; p=0.610) and S-ICH (OR, 1.313; 95% CI, 0.603-2.861; p=0.493) did not differ significantly. Good clinical outcome was more evident in M2 occlusion after EVT than that in M1 occlusion (OR, 1.639; 95% CI, 1.135-2.368; p=0.008). However, mortality did not differ significantly according to thrombus location (OR, 0.788; 95% CI, 0.486-1.276; p=0.332).
EVT seems to be technically feasible for acute M2 occlusion. Direct comparative studies between EVT and medical treatment are needed further to find specific beneficiary group after EVT in patient with M2 occlusion.
大脑中动脉M2段急性闭塞的血管内治疗（EVT）效果仍不明确，因为大多数结果来自前循环大动脉闭塞患者。本研究的目的是评估急性M2闭塞的手术效果，并根据血栓位置（M1与M2）比较结果。
对2004年1月至2016年12月发表的在线文献进行系统综述。主要结局是术后成功再通率和有症状颅内出血（S-ICH）。如果异质性小于50%，则使用固定效应模型。
纳入8篇文章。EVT显示成功再通率为69.1%（95%置信区间[CI]，54.9 - 80.4%），S-ICH率为6.1%（95%CI，4.5 - 8.3%）。3个月时良好临床结局率和死亡率分别为59.4%（95%CI，49.9 - 68.2%）和14.9%（95%CI，11.4 - 19.3%）。根据血栓位置（M1与M2），成功再通（优势比[OR]，1.539；95%CI，0.293 - 8.092；p = 0.610）和S-ICH（OR，1.313；95%CI，0.603 - 2.861；p = 0.493）无显著差异。EVT后M2闭塞的良好临床结局比M1闭塞更明显（OR，1.639；95%CI，1.135 - 2.368；p = 0.008）。然而，根据血栓位置，死亡率无显著差异（OR，0.788；95%CI，0.486 - 1.276；p = 0.332）。
EVT对于急性M2闭塞在技术上似乎是可行的。需要进一步进行EVT与药物治疗之间的直接比较研究，以找到M2闭塞患者中EVT后的特定受益群体。
