Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies

J M Coutinho; D S Liebeskind; L-A Slater; R G Nogueira; B W Baxter; E I Levy; A H Siddiqui; M Goyal; O O Zaidat; A Davalos; A Bonafé; R Jahan; J Gralla; J L Saver; V M Pereira

doi:10.3174/ajnr.A4591

Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies

AJNR Am J Neuroradiol. 2016 Apr;37(4):667-72. doi: 10.3174/ajnr.A4591. Epub 2015 Nov 12.

Authors

J M Coutinho¹, D S Liebeskind², L-A Slater¹, R G Nogueira³, B W Baxter⁴, E I Levy⁵, A H Siddiqui⁶, M Goyal⁷, O O Zaidat⁸, A Davalos⁹, A Bonafé¹⁰, R Jahan¹¹, J Gralla¹², J L Saver¹³, V M Pereira¹⁴

Affiliations

¹ From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.).
² Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California.
³ Marcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
⁴ Department of Radiology (B.W.B.), Erlanger Hospital at University of Tennessee, Chattanooga, Tennessee.
⁵ Department of Neurosurgery (E.I.L., A.H.S.).
⁶ Department of Neurosurgery (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (A.H.S.), State University of New York at Buffalo, Buffalo, New York.
⁷ Departments of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Neurology (O.O.Z.), Medical College of Wisconsin, Milwaukee, Wisconsin.
⁹ Department of Neurosciences (A.D.), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
¹⁰ Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France.
¹¹ Division of Interventional Neuroradiology (R.J.).
¹² Departments of Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
¹³ Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
¹⁴ From the Divisions of Neuroradiology (J.M.C., L.-A.S., V.M.P.) Neurosurgery (V.M.P.), Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada vitormpbr@hotmail.com.

Abstract

Background and purpose: Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies.

Materials and methods: We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3.

Results: We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64).

Conclusions: Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Animals
Brain Ischemia / surgery
Cerebral Hemorrhage / epidemiology
Cerebral Revascularization / methods
Dogs
Female
Humans
Infarction, Middle Cerebral Artery / pathology
Infarction, Middle Cerebral Artery / surgery*
Male
Middle Aged
Multicenter Studies as Topic
Postoperative Complications / epidemiology
Prospective Studies
Reperfusion
Stents / adverse effects
Stroke / surgery
Thrombectomy / adverse effects
Thrombectomy / methods*
Treatment Outcome