Navia Pedro, Barrios Andrés Javier, Utrilla Cristina, Fuentes Blanca, Fernández-Prieto Andrés, Álvarez-Muelas Alberto, Frutos Remedios, Marín Begoña, Royo Arantxa, García-Raya Pilar, Fernández-Zubillaga Amelia, de Celis Elena, Puig Josep, Comas-Cufí Marc, Arráez-Aybar Luis-Alfonso, Garzón Gonzalo
Department of Diagnostic and Interventional Neuroradiology, La Paz University Hospital, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.
Department of Neurology and Stroke Center, La Paz University Hospital, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.
J Neuroimaging. 2025 Jan-Feb;35(1):e70001. doi: 10.1111/jon.70001.
Endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) with M2 segment occlusion of the middle cerebral artery (MCA) is debatable. This study assessed the efficacy, safety, and functional outcomes of EVT in M2 occlusion patients, examining differences in outcomes based on the dominance of the occluded segment (DomM2 vs. Non-DomM2).
A prospective cohort of 108 patients with AIS resulting from M2 segment occlusion of the MCA who underwent EVT was analyzed. We compared demographic, clinical, angiographic, and clinical outcome data (National Institutes of Health Stroke Scale [NIHSS] score at 24 h and modified Rankin Scale [mRS] score at 3 months) between patients with or without DomM2. The primary endpoint was the first-pass effect (FPE), defined as achieving modified Thrombolysis in Cerebral Infarction 2c-3 after one pass. We examined the symptomatic hemorrhagic transformation, 3-month functional outcomes, and mortality rates.
Seventy-five patients (69.44%) had DomM2. FPE rates (48.48% for DomM2; 42.66% for Non-DomM2, p = 0.521), final successful recanalization rate, and functional outcomes were comparable between subgroups. Direct aspiration yielded a higher FPE rate (56.25%). FPE was associated with lower NIHSS scores at discharge (median, 2 [interquartile range 0-4] vs. 5 [1-10]; p < 0.001) and higher 3-month functional independence (83.33% vs. 60.34%; p < 0.001). Direct aspiration independently predicted FPE, with a 75% likelihood compared to stent retriever (p = 0.007).
EVT is a safe and effective treatment for acute M2 occlusion regardless of the dominance of the M2 segment. Direct aspiration used as a frontline technique increases the likelihood of FPE.
大脑中动脉（MCA）M2段闭塞的急性缺血性卒中（AIS）患者行血管内血栓切除术（EVT）存在争议。本研究评估了EVT治疗M2段闭塞患者的疗效、安全性及功能结局，探讨基于闭塞节段优势（优势M2段与非优势M2段）的结局差异。
分析了108例因MCA M2段闭塞接受EVT治疗的AIS患者的前瞻性队列。我们比较了有或无优势M2段患者的人口统计学、临床、血管造影及临床结局数据（24小时美国国立卫生研究院卒中量表[NIHSS]评分及3个月改良Rankin量表[mRS]评分）。主要终点为首次通过效应（FPE），定义为一次通过后达到改良脑梗死溶栓2c - 3级。我们检查了症状性出血转化、3个月功能结局及死亡率。
75例患者（69.44%）有优势M2段。亚组间FPE率（优势M2段为48.48%；非优势M2段为42.66%，p = 0.521）、最终成功再通率及功能结局相当。直接抽吸的FPE率更高（56.25%）。FPE与出院时较低的NIHSS评分相关（中位数，2[四分位间距0 - 4]对5[1 - 10]；p < 0.001）及较高的3个月功能独立性相关（83.33%对60.34%；p < 0.001）。直接抽吸独立预测FPE，与支架取栓器相比可能性为75%（p = 0.007）。
无论M2段优势与否，EVT都是治疗急性M2段闭塞的安全有效方法。直接抽吸作为一线技术可增加FPE的可能性。
