Department of Neurosurgery, University of California, Los Angeles, California, USA.
Division of Interventional Neuroradiology, University of California, Los Angeles, California, USA.
World Neurosurg. 2020 Jul;139:e792-e799. doi: 10.1016/j.wneu.2020.04.159. Epub 2020 May 1.
Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) caused by anterior circulation large-vessel occlusion. However, the true safety and efficacy of MT in medium-size vessel occlusions such as the M2 segment of the middle cerebral artery have yet to be completely defined. In this study, we analyze the safety and efficacy of MT in M2 occlusions compared with M1 occlusions.
A retrospective analysis was performed of patients with AIS secondary to M1 and M2 occlusions between 2011 and 2018. The inclusion criteria were 1) AIS secondary to M1 or M2 occlusion, 2) MT performed by stentrieval technique alone, aspiration technique, or combined stentrieval-aspiration techniques. Basic patient characteristics, number of passages, first passage recanalization success (≥TICI [Thrombolysis in Cerebral Ischemia] grade 2b), total recanalization success, hemorrhagic complications (including intracerebral hemorrhage [ICH] and subarachnoid hemorrhage), and clinical outcomes were compared between both groups.
Two hundred and sixty patients met the inclusion criteria; 171 patients had M1 occlusion versus 89 with M2 occlusion. First passage recanalization success rate was significantly higher in the M2 group (55.1% vs. 39.2%; P = 0.015). Total recanalization success rate was higher in the M2 group but did not reach significance (83% vs. 75%; P = 0.128). Subarachnoid hemorrhage rate was significantly higher in the M2 group (25% vs. 12%; P = 0.010) but there was no difference for ICH complications (14.6% vs. 16.4%; P = 0.711).
MT for M2 occlusions has similar overall efficacy to that for M1 occlusions, but with higher first-pass successful recanalization rates. MT for M2 occlusions has a higher risk of associated subarachnoid hemorrhage.
机械血栓切除术（MT）是治疗前循环大血管闭塞引起的急性缺血性脑卒中（AIS）的标准治疗方法。然而，MT 在中等大小血管闭塞（如大脑中动脉 M2 段）中的真正安全性和疗效尚未完全确定。在这项研究中，我们分析了 MT 在 M2 闭塞与 M1 闭塞中的安全性和疗效。
对 2011 年至 2018 年间因 M1 和 M2 闭塞引起的 AIS 患者进行回顾性分析。纳入标准为：1）因 M1 或 M2 闭塞引起的 AIS；2）仅采用支架取栓术、抽吸技术或联合支架取栓抽吸技术进行 MT。比较两组患者的基本特征、通过次数、首次通过再通成功率（≥血栓溶解度[脑缺血]分级 2b）、完全再通成功率、出血并发症（包括颅内出血[ICH]和蛛网膜下腔出血）和临床转归。
共有 260 例患者符合纳入标准；171 例为 M1 闭塞，89 例为 M2 闭塞。M2 组首次通过再通成功率明显更高（55.1%比 39.2%；P=0.015）。M2 组总再通成功率较高，但未达到显著水平（83%比 75%；P=0.128）。M2 组蛛网膜下腔出血发生率明显更高（25%比 12%；P=0.010），但 ICH 并发症发生率无差异（14.6%比 16.4%；P=0.711）。
MT 治疗 M2 闭塞的总体疗效与 M1 闭塞相似，但首次通过再通成功率更高。MT 治疗 M2 闭塞的并发症发生率较高。
