Behme, D., Kowoll, A., Weber, W. and Mpotsaris, A. (2015). M1 is not M1 in ischemic stroke: the disability-free survival after mechanical thrombectomy differs significantly between proximal and distal occlusions of the middle cerebral artery M1 segment. J. NeuroInterventional Surg., 7 (8). S. 559 - 564. LONDON: BMJ PUBLISHING GROUP. ISSN 1759-8486

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Abstract

Aims Recent recommendations on the designation of target artery lesions in acute ischemic stroke include the anatomical differentiation between a proximal and a distal occlusion site of the M1 segment of the middle cerebral artery (MCA). The aim of this study was to evaluate whether these occlusion types differ in terms of a disability-free (modified Rankin Scale (mRS) 0 or 1) clinical outcome at 90 days. Methods A retrospective analysis was performed of all patients with MCA M1 occlusions who had a successful revascularization result after mechanical thrombectomy between October 2009 and September 2013 and for whom follow-up at 90 days was available. Imaging data were regraded and re-evaluated according to the modified Thrombolysis In Cerebral Infarction (mTICI) scale and the respective vessel occlusion site definitions. Outcome measures included National Institutes of Health Stroke Scale (NIHSS), mRS, Alberta Stroke Program Early CT Score (ASPECTS) scoring and procedural timings. Results 62 patients were successfully recanalized; follow-up at 90 days was available for 42/62 patients (68%). There were proximal MCA occlusions in 24/42 patients (57%) and distal occlusions in 18/42 (43%). Baseline NIHSS, ASPECTS, procedural timings and final mTICI scores did not differ significantly between proximal and distal M1 occlusions. There was a statistically significant difference between proximal and distal M1 occlusions regarding a disability-free early outcome (mRS 0 or 1) at discharge (p=0.03) and at 90 days (p=0.04). Conclusions Proximal occlusions of the M1 segment of the MCA incorporating the lenticulostriate perforators are associated with a poorer clinical outcome than distal M1 occlusions that spare these perforators. Involvement of these perforators might become an additional predictor of clinical outcome after mechanical thrombectomy in ischemic stroke.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Behme, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kowoll, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mpotsaris, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-397749
DOI: 10.1136/neurintsurg-2014-011212
Journal or Publication Title: J. NeuroInterventional Surg.
Volume: 7
Number: 8
Page Range: S. 559 - 564
Date: 2015
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1759-8486
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ANTERIOR CIRCULATION STROKE; COMPUTED-TOMOGRAPHY SCORE; STENT RETRIEVER; ENDOVASCULAR TREATMENT; RECANALIZATION; TANDEMMultiple languages
Neuroimaging; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/39774

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