Middle Cerebral Artery (M2) Aneurysm: Endovascular Treatment of a Ruptured Left MCA (M2) Aneurysm in an Elderly Patient with Good Clinical Outcome

PurposeThe impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy.MethodsWe retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. Good neurological outcome was defined as a modified Rankin Scale score of ≤2 at 90 days after stroke onset.ResultsMean thrombus length was 13.4±5.2 mm. Univariate binary logistic regression did not show an association of thrombus length with the probability of a good clinical outcome (OR 0.95, 95% CI 0.84 to 1.03, p=0.176) or successful recanalization (OR 0.92, 95% CI 0.81 to 1.05, p=0.225). There was no significant correlation between thrombus length and the number of thrombectomy maneuvers needed for recanalization (p=0.112). Furthermore, thrombus length was not correlated with the probability of intraprocedural complications (p=0.813), including embolization in a new territory (n=3).ConclusionsIn this study, thrombus length had no relevant impact on recanalization, neurological outcome, or intraprocedural complications following mechanical thrombectomy of middle cerebral artery occlusions. Therefore, mechanical thrombectomy with stent retrievers can be attempted with large clots.

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Abstract T MP27: Outcome Predictors in Basilar- versus Proximal Middle Cerebral Artery Occlusion: Data from the Endostroke-Registry

Stroke ◽

10.1161/str.45.suppl_1.tmp27 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Oliver C Singer ◽

Joachim Berkefeld ◽

Keyword(s):

Clinical Outcome ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Large Vessel ◽

Stroke Severity ◽

Outcome Predictors ◽

Good Clinical Outcome ◽

Mca Occlusion ◽

Proximal Middle Cerebral Artery ◽

Large Vessel Stroke

Background and Purpose: Large vessel stroke is frequently associated with poor long-term clinical outcome despite multimodal treatment approaches. Here we compare outcome predictors in angiographic proven proximal Middle Cerebral Artery (MCA)- versus Basilar Artery (BA) occlusion undergoing endovascular stroke treatment (EVT). Methods: ENDOSTROKE is an investigator-initiated, industrially-independent multicenter, multinational registry for consecutive patients undergoing EVT for large vessel stroke. This analysis focuses on patients with angiographically proven M1-MCA (n=352) or BA-occlusion (n=121). Recanalization was defined as Thrombolysis in Cerebral Ischemia (TICI) scores 2b-3, good outcome as a Modified Rankin Scale (MRS) score of 0-2 assessed after 3 months. Results: 77% of MCA- and 77% of BA-occlusions reached TICI 2b-3 recanalization, but good clinical outcome was achieved in only 31% vs. 40% of BA- vs. MCA-occlusions (n.s., Mann-Whitney-Test). Median age was 67 years (25 th and 75 th percentile: 59, 77) in BA-occlusion and 70 (58, 77) in MCA-occlusion (n.s.). Admission-NIHSS was significantly higher in BA-occlusion (22 (10, 29)) than in MCA-occlusion (15 (12, 19), p<0.001). Serum glucose and thromboycte count were not significantly different between MCA- and BA-occlusions. In MCA-occlusion, independent factors significantly associated with good clinical outcome were lower age, lower initial NIHSS, lower glucose as well as TICI 2b-3 recanalization. In BA-occlusion, only lower initial NIHSS was significantly associated with good clinical outcome (univariate and multivariate analysis). Time to recanalization was not significantly related to outcome in MCA- or BA-occlusions. Conclusions: While initial stroke severity is a potent prognostic factor in both, MCA- and BA-occlusion, other classical outcome predictors, especially patients′ age do not seem to be of as high importance in BA-occlusion as in MCA-occlusion. Presumably, those predictors are offset by the exact site of BA-occlusion (i.e. mid-basilar vs. top of the basilar) leading to differences in initial stroke severity and potentially early irreversible tissue damage to pivotal brain stem structures.

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