Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry
Background Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the...
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| Format: | Article |
| Language: | English |
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Wiley
2023-05-01
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| Series: | Stroke: Vascular and Interventional Neurology |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000664 |
| _version_ | 1827955331188129792 |
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| author | Kaustubh Limaye Andrew B. Koo Adam de Havenon Sami Al Kasab Bradley Bohnstedt Ilko L. Maier Marios‐Nikos Psychogios Stacey Wolfe Adam Arthur Peter Kan Joon‐Tae Kim Reade De Leacy Joshua Osbun Ansaar Rai Pascal Jabbour Min Park Roberto Crosa Justin Mascitelli Michael R. Levitt Adam Polifka Walter Casagrande Shinichi Yoshimura Richard W. Williamson Benjamin Gory Maxim Mokin Isabel Fragata Daniele G. Romano Shakeel Chowdry Amir Shaban Mark Moss Daniel Behme Alejandro M. Spiotta Charles Matouk |
| author_facet | Kaustubh Limaye Andrew B. Koo Adam de Havenon Sami Al Kasab Bradley Bohnstedt Ilko L. Maier Marios‐Nikos Psychogios Stacey Wolfe Adam Arthur Peter Kan Joon‐Tae Kim Reade De Leacy Joshua Osbun Ansaar Rai Pascal Jabbour Min Park Roberto Crosa Justin Mascitelli Michael R. Levitt Adam Polifka Walter Casagrande Shinichi Yoshimura Richard W. Williamson Benjamin Gory Maxim Mokin Isabel Fragata Daniele G. Romano Shakeel Chowdry Amir Shaban Mark Moss Daniel Behme Alejandro M. Spiotta Charles Matouk |
| author_sort | Kaustubh Limaye |
| collection | DOAJ |
| description | Background Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the delayed time window (>6 hours). Methods The Stroke Thrombectomy and Aneurysm Registry (STAR) is a prospective, multicenter, nonrandomized observational study registry for acute ischemic stroke thrombectomy and aneurysm treatment. We analyzed all patients who underwent mechanical thrombectomy within the late time window (>6 hours from symptom onset) involving isolated M2 occlusions. We used propensity score matching to select a comparison group of patients who underwent mechanical thrombectomy for M1 occlusion in the same time window. Results Of 1083 consecutive patients analyzed, propensity matching yielded 180 well matched M1 and M2 pairs. Baseline demographics were well balanced between the groups (M1 and M2). Alberta stroke program early CT score (7.6±1.7 versus 8.3±1.5; P<0.001) was higher in the M2 group. There was a trend towards less complete recanalization (Thrombolysis in Cerebral Infarction 3) 46.1% versus 39.9% (P=0.053) in the middle cerebral artery M2 segment cohort. However, successful recanalization (Thrombolysis in Cerebral Infarction 2b‐3) was better in middle cerebral artery M2 segment cohort (85% versus 90.5%; P=0.053). Postprocedural asymptomatic hemorrhage rates were similar (29.4% versus 27.8%; P=0.816), but symptomatic hemorrhage rates were higher in the M1 group (7.2% versus 2.2%; P=0.047). Rates of good clinical outcome (modified Rankin scale 0–2) were similar at final follow‐up (43.9% versus 46.7%; P=0.672). The overall mortality was also similar between the cohorts (12.8% versus 13.9%; P=0.877). Conclusion In our analysis of the Stroke Thrombectomy and Aneurysm Registry, M2 occlusions not only achieved similar rates of recanalization and good functional outcome compared with M1 occlusions in a delayed time window (6–24 hours from last normal) but also had less symptomatic intracranial hemorrhage. |
| first_indexed | 2024-04-09T14:45:12Z |
| format | Article |
| id | doaj.art-05f50b10bf17419ca1ca91941c30809a |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-09T14:45:12Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-05f50b10bf17419ca1ca91941c30809a2023-05-02T18:30:22ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-05-013310.1161/SVIN.122.000664Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR RegistryKaustubh Limaye0Andrew B. Koo1Adam de Havenon2Sami Al Kasab3Bradley Bohnstedt4Ilko L. Maier5Marios‐Nikos Psychogios6Stacey Wolfe7Adam Arthur8Peter Kan9Joon‐Tae Kim10Reade De Leacy11Joshua Osbun12Ansaar Rai13Pascal Jabbour14Min Park15Roberto Crosa16Justin Mascitelli17Michael R. Levitt18Adam Polifka19Walter Casagrande20Shinichi Yoshimura21Richard W. Williamson22Benjamin Gory23Maxim Mokin24Isabel Fragata25Daniele G. Romano26Shakeel Chowdry27Amir Shaban28Mark Moss29Daniel Behme30Alejandro M. Spiotta31Charles Matouk32Department of Neurology Neurosurgery and Radiology Indiana University Indianapolis INDepartment of Neurosurgery Yale University New Haven CTDepartment of Neurology Yale University New Haven CTDepartment of Neurology and Neurosurgery Medical University of South Carolina Charleston SCDepartment of Neurosurgery and Neurology Indiana University Indianapolis INDepartment of Neurology University Medical Center Göttingen Göttingen GermanyDepartment of Radiology University of Basel Basel SwitzerlandDepartment of Neurosurgery Wake Forest School of Medicine Winston‐Salem NCDepartment of Neurosurgery Semmes‐Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis TNDepartment of Neurosurgery University of Texas Medical Branch Galveston TXDepartment of Neurology Chonnam National University Medical School Chonnam National University Hospital Gwangju South KoreaDepartment of Neurology and Neurosurgery Mount Sinai New York NYDepartment of Neurosurgery Washington University St. Louis MODepartment of Radiology West Virginia School of Medicine Morgantown WVDepartment of Neurosurgery Thomas Jefferson University Philadelphia PADepartment of Neurosurgery UVA Health Charlottesville VADepartment of Neurosurgery Endovascular Neurological Center Montevideo UruguayDepartment of Neurosurgery University of Texas Health Science Center at San Antonio San Antonio TXDepartment of Neurosurgery University of Washington Seattle WADepartment of Neurosurgery University of Florida Gainesville FLDepartment of Cerebrovascular and Endovascular Neurosurgery Hospital Juan Fernandez Buenos Aires ArgentinaDepartment of Neurosurgery Hyogo College of Medicine Nishinomiya Hyogo JapanDepartment of Neurosurgery Allegheny Health Network Pittsburgh PADepartment of Diagnostic and Therapeutic Neuroradiology Centre Hospitalier Régional Universitaire de Nancy Nancy FranceDepartment of Neurosurgery University of South Florida Tampa FLNeuroradiology Department Hospital São José Centro Hospitalar Lisboa PortugalDepartment of Radiology A.O.U. S. Giovanni di Dio e Ruggi d'Aragona Salerno ItalyDepartment of Neurosurgery Northshore University HealthSystem Evanston ILDepartment of Neurology The Unievrsity of Iowa Iowa City IADepartment of Interventional Neuroradiology Washington Regional Medical Center Fayetteville ARDepartment of Neuroradiology University Medical Center Göttingen GermanyDepartment of Neurosurgery Medical University of South Carolina Charleston SCDepartment of Neurosurgery Yale University New Haven CTBackground Mechanical thrombectomy of middle cerebral artery M2 segment occlusion of the middle cerebral artery has reported safety and efficacy in recent post‐hoc and observational studies. However, there is no known benefit of mechanical thrombectomy for patients with M2 segment occlusions in the delayed time window (>6 hours). Methods The Stroke Thrombectomy and Aneurysm Registry (STAR) is a prospective, multicenter, nonrandomized observational study registry for acute ischemic stroke thrombectomy and aneurysm treatment. We analyzed all patients who underwent mechanical thrombectomy within the late time window (>6 hours from symptom onset) involving isolated M2 occlusions. We used propensity score matching to select a comparison group of patients who underwent mechanical thrombectomy for M1 occlusion in the same time window. Results Of 1083 consecutive patients analyzed, propensity matching yielded 180 well matched M1 and M2 pairs. Baseline demographics were well balanced between the groups (M1 and M2). Alberta stroke program early CT score (7.6±1.7 versus 8.3±1.5; P<0.001) was higher in the M2 group. There was a trend towards less complete recanalization (Thrombolysis in Cerebral Infarction 3) 46.1% versus 39.9% (P=0.053) in the middle cerebral artery M2 segment cohort. However, successful recanalization (Thrombolysis in Cerebral Infarction 2b‐3) was better in middle cerebral artery M2 segment cohort (85% versus 90.5%; P=0.053). Postprocedural asymptomatic hemorrhage rates were similar (29.4% versus 27.8%; P=0.816), but symptomatic hemorrhage rates were higher in the M1 group (7.2% versus 2.2%; P=0.047). Rates of good clinical outcome (modified Rankin scale 0–2) were similar at final follow‐up (43.9% versus 46.7%; P=0.672). The overall mortality was also similar between the cohorts (12.8% versus 13.9%; P=0.877). Conclusion In our analysis of the Stroke Thrombectomy and Aneurysm Registry, M2 occlusions not only achieved similar rates of recanalization and good functional outcome compared with M1 occlusions in a delayed time window (6–24 hours from last normal) but also had less symptomatic intracranial hemorrhage.https://www.ahajournals.org/doi/10.1161/SVIN.122.000664extended time window treatmentmedium vessel occlusionstrokethrombectomy |
| spellingShingle | Kaustubh Limaye Andrew B. Koo Adam de Havenon Sami Al Kasab Bradley Bohnstedt Ilko L. Maier Marios‐Nikos Psychogios Stacey Wolfe Adam Arthur Peter Kan Joon‐Tae Kim Reade De Leacy Joshua Osbun Ansaar Rai Pascal Jabbour Min Park Roberto Crosa Justin Mascitelli Michael R. Levitt Adam Polifka Walter Casagrande Shinichi Yoshimura Richard W. Williamson Benjamin Gory Maxim Mokin Isabel Fragata Daniele G. Romano Shakeel Chowdry Amir Shaban Mark Moss Daniel Behme Alejandro M. Spiotta Charles Matouk Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry Stroke: Vascular and Interventional Neurology extended time window treatment medium vessel occlusion stroke thrombectomy |
| title | Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry |
| title_full | Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry |
| title_fullStr | Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry |
| title_full_unstemmed | Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry |
| title_short | Safety and Efficacy of MCA‐M2 Thrombectomy in Delayed Time Window: A Propensity Score Analysis From the STAR Registry |
| title_sort | safety and efficacy of mca m2 thrombectomy in delayed time window a propensity score analysis from the star registry |
| topic | extended time window treatment medium vessel occlusion stroke thrombectomy |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000664 |
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