Complete recanalization predicts favorable outcome in patients with distal M2-M3 middle cerebral artery occlusions following endovascular thrombectomy

Mohamed Abdelrady; Imad Derraz; Cyril Dargazanli; Mourad Cheddad El Aouni; Pierre-Henri Lefevre; Federico Cagnazzo; Carlos Riquelme; Gregory Gascou; Caroline Arquizan; Isabelle Mourand; Douraied Ben Salem; Vincent Costalat; Jean-Christophe Gentric; Julien Ognard

doi:10.1016/j.neurad.2022.11.007

Complete recanalization predicts favorable outcome in patients with distal M2-M3 middle cerebral artery occlusions following endovascular thrombectomy

J Neuroradiol. 2023 Mar;50(2):230-236. doi: 10.1016/j.neurad.2022.11.007. Epub 2022 Nov 24.

Authors

Affiliations

¹ Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France; Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France; Department of Neuroradiology, El-Demerdash university hospital, Cairo, Egypt. Electronic address: Mohamed_abdelrady@med.asu.edu.eg.
² Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France.
³ Department of Neuroradiology, Hôpital Cavale Blanche, Brest University hospital, Brest, France.
⁴ Department of Neurology, Hôpital Gui de Chauliac, Montpellier University hospital, Montpellier, France.

PMID: 36436611
DOI: 10.1016/j.neurad.2022.11.007

Abstract

Background: - scanty articles illustrate the prognostic factors for favorable outcome after endovascular thrombectomy (EVT) in distal vessel occlusion (DMVO). Moreover, the current literature is diversified; conglomerating both primary, secondary, and anterior, posterior circulations embolic strokes in the same shell.

Purpose: to identify the association between complete reperfusion and favorable outcome following EVT for DMVO in the middle cerebral artery (MCA) territory.

Methods: -we performed a retrospective analysis of prospectively maintained EVT registries at two comprehensive stroke centers between January 2015 and December 2019 for consecutive stroke patients with MCA-DMVO. DMVO was defined as an occlusion of distal M2 and M3 segments of the MCA. Only patients with primary isolated occlusions were included. A multivariate logistic regression was utilized to identify clinical and procedural-related factors associated with the 90-day favorable clinical outcome [defined as modified Rankin score (mRS) 0-2] after EVT.

Results: -Out of 1823 within the registries; 66 patients (median age was 72 (60-78) and 59% were males) with primary isolated DMVO of the MCA were eligible for inclusion in the current study. Complete reperfusion was achieved in 56% (37/66) of the patients with no difference among the reperfusion strategies while the favorable outcome was observed in 68% (45/66). In the multivariate analysis, final complete reperfusion [modified Thrombolysis In Cerebral Infarction (mTICI) score 2c-3] was significantly associated with favorable outcome [aOR=7.69; (95% CI 1.73-34.17); p=.01], while higher baseline NIHSS score [aOR=0.82; (95% CI 0.69-0.98); p=.03] and increased imaging to puncture interval [aOR=0.99; (95% CI 0.98, 1.00); p=.01] decreased the probability of the favorable outcome.

Conclusion: according to our results, complete reperfusion was the most significant predictor of the favorable outcome, while higher baseline NIHSS and longer imaging to puncture interval decreased the probability of the favorable outcome.

Keywords: DMVO; Distal occlusion; Ischemic Stroke; Outcome; Thrombectomy.

MeSH terms

Aged
Brain Ischemia* / etiology
Endovascular Procedures* / methods
Female
Humans
Infarction, Middle Cerebral Artery / etiology
Male
Retrospective Studies
Stroke* / etiology
Thrombectomy / methods
Treatment Outcome