Endovascular Treatment of Middle Cerebral Artery M2 Occlusion Strokes: Clinical and Procedural Predictors of Outcomes

Neurosurgery. 2017 Nov 1;81(5):795-802. doi: 10.1093/neuros/nyx060.


Background: Patients with strokes from M2 segment middle cerebral artery (MCA) occlusion have been underrepresented in recent randomized trials of endovascular therapy.

Objective: To better understand the clinical, imaging, and procedural predictors of successful recanalization and clinical outcomes in this population of patients.

Methods: We performed a multicenter retrospective analysis of consecutive patients with acute MCA M2 segment occlusion who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics.

Results: One hundred and seventeen patients were included in analysis (median admission National Institutes of Health stroke scale [NIHSS] score 15, mean age 67.0 ± 14.5, 42% females). Good clinical outcome at 3 months (modified Rankin scale [mRS] ≤ 2) was achieved in 56% of patients. Treatment beyond 6 h of symptoms onset (P = .69, OR 0.80, 95% CI 0.38-1.73) and age over 80 (P = .47, OR 0.65, 95% CI 0.25-1.70) were not predictive of poor outcome. NIHSS > 15 was a strong predictor of clinical outcome, based on mRS distribution at 3 months (P = .0085, OR 0.35, 95% CI 0.16-0.74). Direct aspiration and primary stent retriever thrombectomy approaches showed similar radiographic and clinical success rates.

Conclusion: Advanced age and time to treatment beyond 6 h from symptom onset were not predictive of clinical outcome with thrombectomy. NIHSS score above 15 was a strong predictor of outcome. Direct aspiration and primary stent retriever thrombectomy showed similar efficacy.

Keywords: Acute stroke; Middle cerebral artery; Thrombectomy.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / surgery*
  • Male
  • Middle Aged
  • Middle Cerebral Artery / surgery
  • Retrospective Studies
  • Stents / adverse effects
  • Stroke / surgery*
  • Thrombectomy / methods*
  • Treatment Outcome