Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
Service of Radiology and Neuroradiology, University Hospital of Tours, Tours, France.
J Neurointerv Surg. 2021 Sep;13(9):779-783. doi: 10.1136/neurintsurg-2020-016427. Epub 2020 Nov 20.
The benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.
To compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.
We performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0-2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion.
We included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87).
In ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.
急性大脑中动脉 M2 段闭塞的血管内血栓切除术的获益仍存在争议，且针对该人群的数据不确定且稀少。
在血管内取栓治疗缺血性卒中的再灌注评估（ARISE II）试验中比较 M1 和 M2 段闭塞的结局。
我们对 ARISE II 试验进行了预设分析，主要结局为 90 天改良 Rankin 量表评分 0-2，我们称之为良好结局。次要结局包括再灌注率和主要不良事件。主要预测指标为 M2 段闭塞，我们将其与 M1 段闭塞进行比较。
我们纳入了 183 例患者，其中 126 例（69%）存在 M1 段闭塞，57 例（31%）存在 M2 段闭塞。M2 和 M1 段闭塞的再灌注率和不良事件发生率没有差异。M2 段闭塞与 M1 段闭塞的良好结局率也没有差异（70.2% vs 69.7%，p=0.946）。在调整年龄、性别和基线国立卫生研究院卒中量表评分的 logistic 回归模型中，M2 段闭塞与 M1 段闭塞相比，良好结局的可能性没有显著差异（OR 0.94，95%CI 0.47 至 1.88，p=0.87）。
在 ARISE II 中，M2 段闭塞在 90 天时达到了 70.2%的良好结局率，高于未经治疗的 M2 段闭塞的发表率，优于先前报告的 M2 段闭塞采用血管内取栓治疗的结果。当比较 M1 和 M2 段闭塞时，我们还报告了相似的良好结局、成功再灌注、死亡和其他不良事件发生率。
