Endovascular treatment for acute M2 occlusion stroke within 6 hours-a retrospective real-world evidence

Yi Xu; Wang Fu; Yongpeng Wang; Qianqian Bi; Qiwei Wang; Lu Yang; Quanbin Zhang; Feng Wang

doi:10.3389/fcvm.2022.1063078

Endovascular treatment for acute M2 occlusion stroke within 6 hours-a retrospective real-world evidence

Front Cardiovasc Med. 2023 Jan 10:9:1063078. doi: 10.3389/fcvm.2022.1063078. eCollection 2022.

Authors

Yi Xu¹, Wang Fu², Yongpeng Wang², Qianqian Bi², Qiwei Wang², Lu Yang², Quanbin Zhang¹, Feng Wang²

Affiliations

¹ Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

Background: We compared the efficacy and safety of endovascular therapy (EVT), intravenous (IV) thrombolysis and conservative treatment in M2 segment occlusion stroke based on a real-world database.

Methods: We retrospectively analyzed the database of admitted patients with M2 segment occlusion between January 2018 and December 2020. The patients who were eligible for reperfusion treatment were assigned to EVT, IV thrombolysis or conservative treatment according to the exact management proceeding. The primary outcome was a score of 0 and 1 on the modified Rankin scale (mRS) at 90 days. The odds ratio (OR) for the primary outcome was adjusted for age, baseline National Institute of Health Stroke Scale score, and door-to-treatment time. The secondary outcomes were based on a mRS score from 0 to 2 at 90 days and the safety outcomes including symptomatic intracranial hemorrhage, and all-cause mortality. The data were analyzed by the logistical regression model, including baseline adjustments.

Results: A total of 109 patients were included. Among them, 42 (38.5%) patients received EVT, 45 (42.5%) received IV thrombolysis and 22 (20.8%) received conservative treatment. The primary outcome based on a mRS score of 0 and 1, occurred in 66.7% of patients in the EVT group and 40% in the IV thrombolysis group (adjusted OR, 1.79; 95% confidence interval [CI], 1.19-2.68; P = 0.01). Symptomatic intracranial hemorrhage occurred in 1 patient (2.3%) in the EVT group and in 2 patients (4.4%) in the IV thrombolysis group (adjusted OR = 0.71, 95% CI: 0.13-4.07).

Conclusion: EVT showed better functional outcomes than IV thrombolysis and conservative treatment in moderate to severe acute stoke patients with M2 occlusion. There was no significant difference in the three groups concerning the incidence of symptomatic intracranial hemorrhage.

Keywords: M2 occlusion; acute ischemic stroke; endovascular therapy; intravenous thrombolysis; stroke.

Grants and funding

This research was funded by the 2021 Scientific Research Project of Shanghai Municipal Commission of Health and Family Planning (202140282), 2020 Health Science and Technology Project of Pudong New Area Health Commission (PW2020D-5), Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai (PWR12020-03), 2020 Science and Technology Development Fund of Pudong New Area Special Fund for People’s Livelihood Scientific Research (PKJ2020-Y-15), and the Key Discipline in Pudong New Area Health Commission (PWZxq2022-01).