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Original research
M2 occlusions as targets for endovascular therapy: comprehensive analysis of diffusion/perfusion MRI, angiography, and clinical outcomes
  1. Sunil A Sheth1,
  2. Bryan Yoo2,
  3. Jeffrey L Saver1,
  4. Sidney Starkman1,3,
  5. Latisha K Ali1,
  6. Doojin Kim1,
  7. Nestor R Gonzalez4,5,
  8. Reza Jahan4,
  9. Satoshi Tateshima4,
  10. Gary Duckwiler4,
  11. Fernando Vinuela4,
  12. David S Liebeskind1
  13. for the UCLA Comprehensive Stroke Center
  1. 1Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
  2. 2Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
  3. 3Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California, USA
  4. 4Division of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA
  5. 5Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr David S Liebeskind, Department of Neurology, UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA 90095, USA; davidliebeskind{at}yahoo.com

Abstract

Background The ideal population of patients for endovascular therapy (ET) in acute ischemic stroke remains undefined. Recent ET trials have moved towards selecting patients with proximal middle cerebral artery (MCA) or internal carotid artery occlusions, which will likely leave a gap in our understanding of the treatment outcomes of M2 occlusions.

Objective and methods To examine the presentation, treatment, and outcomes of M2 compared with M1 MCA occlusions in patients undergoing ET by assessing comprehensive MRI, angiography, and clinical data.

Results We found that M2 occlusions can lead to massive strokes defined by hypoperfused and infarcted volumes as well as death or moderate to severe disability in nearly 50% of patients at discharge. Compared with M1 occlusions, M2 occlusions achieved similar Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization rates, with significantly less hemorrhage. M2 occlusions presented with smaller infarct and hypoperfused volumes and had smaller final infarct volumes regardless of recanalization. TICI 2b/3 recanalization of M2 occlusions was associated with smaller infarct volumes compared with TICI 0–2a recanalization, as well as less infarct expansion, in patients who received IV tissue plasminogen activator as well as those that did not. Successful reperfusion of M2 occlusions was associated with improved discharge modified Rankin scale.

Conclusions If suitable as targets of ET, M2 occlusions should be given the same consideration as M1 occlusions.

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