Mechanical Thrombectomy for M2 Segment Occlusion in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Yuxuan Xing; Xin Jiang; Kangtai Su; Ruoxi Cheng; Lingfeng Lai

doi:10.1016/j.wneu.2022.06.065

Mechanical Thrombectomy for M2 Segment Occlusion in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

World Neurosurg. 2022 Sep:165:e393-e400. doi: 10.1016/j.wneu.2022.06.065. Epub 2022 Jun 22.

Authors

Yuxuan Xing¹, Xin Jiang², Kangtai Su¹, Ruoxi Cheng³, Lingfeng Lai⁴

Affiliations

¹ The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
² Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
³ Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
⁴ Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. Electronic address: laiweiwei1986@163.com.

PMID: 35750141
DOI: 10.1016/j.wneu.2022.06.065

Abstract

Background: The safety and benefit of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) patients with M2 segment middle cerebral artery occlusions remain uncertain.

Objective: To investigate the benefit of mechanical thrombectomy for M2 occlusion compared with M1 occlusion in patients with AIS.

Methods: The PubMed, Embase, and Cochrane Library databases were searched from inception to April 2021 to identify relevant articles. The main results comprised 90-day functional independence (modified Rankin Score from 0-2), successful recanalization (thrombectomy in cerebral infarction [TICI] 2b/3), mortality, and rates of symptomatic intracerebral hemorrhage after using modern thrombectomy devices. Odds ratios (ORs) were generated for binary variants. ReviewManager 5.3 software was used.

Results: Ultimately, a total of 14 trials were included, with 3454 participants enrolled. MT for M2 occlusion had a higher rate of 3-month functional independence than M1 occlusion, but the difference was nonsignificant (OR: 1.19, 95% confidence interval [CI]: 0.98 to 1.46). The TICI2b/3 scores (OR: 0.71, 95% CI: 0.58-0.88) in M2 occlusion were remarkably lower than those in M1. The mortality and symptomatic intracerebral hemorrhage rates were comparable between the 2 groups. When comparing M2 and M1 occlusions, we found that there was no significant difference between stent retriever and aspiration in the modified Rankin Score (0-2) after AIS, but aspiration exerted an eminently higher recanalization rate with regard to TICI2b/3 (OR: 0.77, 95% CI: 0.61-0.96).

Conclusions: Compared with M1 occlusion, patients with M2 occlusion treated by MT demonstrated similar clinical outcomes in this study. Moreover, there was no difference between stent retriever and aspiration in treating M2 occlusion in terms of functional independence at 90 days. However, aspiration exerted a conspicuously higher recanalization rate in M2 occlusion than in M1 occlusion.

Keywords: M1-MCA occlusion; M2-MCA occlusion; Mechanical; Stroke; Thrombectomy.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / etiology
Brain Ischemia* / surgery
Cerebral Hemorrhage / etiology
Cerebral Hemorrhage / surgery
Humans
Infarction, Middle Cerebral Artery / etiology
Ischemic Stroke* / surgery
Retrospective Studies
Stents / adverse effects
Stroke* / etiology
Stroke* / surgery
Thrombectomy / methods
Treatment Outcome