Endovascular Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery: a Safe and Effective Procedure

2022 ◽  
Author(s):  
Adrien Marchal ◽  
Martin Bretzner ◽  
Barbara Casolla ◽  
Maeva Kyheng ◽  
Julien Labreuche ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Effective Procedure ◽  
Endovascular Thrombectomy

scholarly journals Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study

2020 ◽  
pp. neurintsurg-2020-016427
Author(s):  
Adam de Havenon ◽  
Ana Paula Narata ◽  
Aymeric Amelot ◽  
Jeffrey L Saver ◽  
Hormozd Bozorgchami ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Scale Score ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Endovascular Thrombectomy ◽  
Good Outcome ◽  
Cerebral Artery Occlusion

BackgroundThe benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.ObjectiveTo compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.MethodsWe performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0–2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion.ResultsWe included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87).ConclusionIn ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.

scholarly journals Thrombus Migration in the Middle Cerebral Artery: Incidence, Imaging Signs, and Impact on Success of Endovascular Thrombectomy

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Johannes Kaesmacher ◽  
Christian Maegerlein ◽  
Mirjam Kaesmacher ◽  
Claus Zimmer ◽  
Holger Poppert ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Thrombectomy ◽  
Imaging Signs

scholarly journals Successful Mechanical Thrombectomy of Middle Cerebral Artery Occlusion 14 Hours after Stroke Onset

2021 ◽  
Vol 3 (01) ◽  
pp. 42-44
Author(s):  
Robin Bhattarai ◽  
Karuna Tamrakar Karki ◽  
Dinesh Kumar Thapa ◽  
Navin Kumar Yadav
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Stroke Onset ◽  
Therapeutic Window ◽  
Left Middle Cerebral Artery ◽  
Significant Past Medical History ◽  
Endovascular Thrombectomy ◽  
Cerebral Artery Occlusion

A 45-year-old patient with no significant past medical history presented to out-patient department with aphasia and right hand weakness with a National Institutes of Health Stroke Scale (NIHSS) of 10 and occlusion of the left middle cerebral artery (MCA) in the M1 segment. Last known normal time was 14hrs (wake up stroke). Immediate endovascular thrombectomy was performed 14 hours after symptom onset with complete recanalization and complete clinical recovery. Although mechanical thrombectomy is generally considered an effective alternative strategy up to 8 hours after stroke onset, selected patients with a large diffusion/perfusion mismatch and small infarct cores may benefit from an expanded therapeutic window.

scholarly journals The transient intraluminal filament middle cerebral artery occlusion model as a model of endovascular thrombectomy in stroke

2015 ◽  
Vol 36 (2) ◽  
pp. 363-369 ◽  
Author(s):  
Brad A Sutherland ◽  
Ain A Neuhaus ◽  
Yvonne Couch ◽  
Joyce S Balami ◽  
Gabriele C DeLuca ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Clinical Relevance ◽  
Artery Occlusion ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Cerebral Artery Occlusion

The clinical relevance of the transient intraluminal filament model of middle cerebral artery occlusion (tMCAO) has been questioned due to distinct cerebral blood flow profiles upon reperfusion between tMCAO (abrupt reperfusion) and alteplase treatment (gradual reperfusion), resulting in differing pathophysiologies. Positive results from recent endovascular thrombectomy trials, where the occluding clot is mechanically removed, could revolutionize stroke treatment. The rapid cerebral blood flow restoration in both tMCAO and endovascular thrombectomy provides clinical relevance for this pre-clinical model. Any future clinical trials of neuroprotective agents as adjuncts to endovascular thrombectomy should consider tMCAO as the model of choice to determine pre-clinical efficacy.

scholarly journals Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration

2019 ◽  
Vol 11 (11) ◽  
pp. 1065-1069 ◽  
Author(s):  
Bijoy K Menon ◽  
Michael D Hill ◽  
Antoni Davalos ◽  
Yvo B W E M Roos ◽  
Bruce C V Campbell ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Effect ◽  
Meta Analysis ◽  
Operational Definition ◽  
Hermes Collaboration ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Trial Protocols

BackgroundThe Society of Neurointerventional Surgery revised its operational definition of emergent large vessel occlusion (ELVO) recently to include proximal M2 segment middle cerebral artery (MCA) occlusions. We sought to assess the benefit of endovascular thrombectomy (EVT) over best medical care for M2 segment MCA occlusion.MethodsPatient level data from trials in the HERMES Collaboration were included. The HERMES core laboratory identified patients with M2 segment MCA occlusions and further classified them as proximal versus distal, anterior versus posterior division, and dominant versus co-dominant versus non-dominant. Primary outcome was modified Rankin Scale (mRS) score 0–2 at 90 days. Secondary outcomes were modified Thrombolysis in Cerebral Infarction (mTICI) rates at end of procedure, 90-day mRS shift, 90-day mRS 0–1, 24 hours National Institute of Health Stroke Scale (NIHSS) score 0–2, symptomatic intracerebral hemorrhage (ICH), and death.Results130 patients with M2 MCA (proximal location n=116 vs distal n=14, anterior division n=72 vs posterior n=58, dominant n=73 vs co-dominant n=50 vs non-dominant n=7) were included. Successful reperfusion (mTICI 2b or 3) among those undergoing EVT was seen in 59.2% of patients. Treatment effect favored EVT (adjusted OR 2.39, 95% CI 1.08 to 5.28, p=0.03) for 90-day mRS 0–2 (58.2% EVT vs 39.7% control). Direction of benefit favored EVT for other outcomes. Treatment effect favoring EVT was maximal in patients with proximal M2 segment MCA occlusions (n=116, adjusted OR 2.68, 95% CI 1.13 to 6.37) and in dominant M2 segment MCA occlusions (n=73, adjusted OR 4.08, 95% CI 1.08 to 15.48). No sICH (0%) was observed in patients treated with EVT compared with five (7.9%) in the control arm.ConclusionPatients with proximal M2 segment MCA occlusions eligible for EVT trial protocols benefited from EVT.

An ultrastructural analysis of the sympathetic innervation of the rabbit ear artery and middle cerebral artery and their branches

1992 ◽  
Vol 50 (1) ◽  
pp. 934-935
Author(s):  
John T. Dodge ◽  
John A. Bevan
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sympathetic Innervation ◽  
Electrical Field Stimulation ◽  
Rabbit Ear Artery ◽  
Electrical Field ◽  
Functional Differences ◽  
Ear Artery ◽  
Rabbit Ear ◽  
Vascular Beds

Unlike many peripheral vascular beds, the sympathetic nervous system exerts little control on cerebral blood flow. The contractile response of isolated rabbit middle cerebral artery (MCA) segments to electrical field stimulation of its intramural nerves is less than in a similar-sized artery from the ear. This study was undertaken to characterize and compare the perivascular neuromuscular relationships and innervation density of similar-sized arteries varying in diameter from these two different regional arterial beds to see if there were structural correlates for these functional differences.

Expression of neurocan after transient middle cerebral artery occlusion in adult rat brain

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S217-S217
Author(s):  
Kentaro Deguchi ◽  
Mikiro Takaishi ◽  
Takeshi Hayashi ◽  
Atsuhiko Oohira ◽  
Shoko Nagotani ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Rat Brain ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Adult Rat ◽  
Adult Rat Brain ◽  
Cerebral Artery Occlusion
Sign in / Sign up

Export Citation Format

Share Document