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Ischemic Stroke
Original research
Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2
  1. Masatomo Miura1,2,3,
  2. Shinichi Yoshimura1,
  3. Nobuyuki Sakai4,
  4. Hiroshi Yamagami5,
  5. Kazutaka Uchida1,6,
  6. Yoichiro Nagao1,3,
  7. Takeshi Morimoto6
  1. 1 Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
  2. 2 Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
  3. 3 Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
  4. 4 Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe City, Hyogo, Japan
  5. 5 Division of Stroke Care Unit, NCVC, Suita, Osaka, Japan
  6. 6 Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
  1. Correspondence to Professor Shinichi Yoshimura, Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya 663-8131, Japan; hyogoneuro{at}yahoo.co.jp

Abstract

Objective To compare the efficacy of endovascular therapy (EVT) with that of medical treatment in ’real-world ’patients with M2 occlusion.

Methods This was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0–2 at 90 days) using forest plots of treatment effects.

Results Overall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9–19] vs 10 [5–16]) and earlier onset to hospital door time (110 [50–258] vs 150 [60–343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.

Conclusion In patients with M2 occlusion, our registry suggests that EVT is effective and safe.

  • Endovascular therapy
  • middle cerebral artery occlusion
  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2018-014627

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    Footnotes

    • Contributors MM performed the statistical analysis and wrote the first draft of the article. This article was supervised by KU, SY, NS, HY, and TM. Those authors made substantial contributions to the conception and design of the RESCUE-Japan Registry 2. KU and YN made contributions to the data analysis and interpretation of data. KU, SY, NS, HY, YN, and TM also contributed to drafting the article and its critical revision for important intellectual content. All authors have approved the final manuscript for submission.

    • Funding The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2 was supported in part by the Japan Agency for Medical Research and Development; the Japanese Society for Neuroendovascular Therapy; the Ministry of Health, Labour, and Welfare of Japan; Medtronic; Stryker; and Medicos Hirata. The funding sources did not participate in any part of the study, from study conception to manuscript preparation.

    • Competing interests MM reports no disclosures. SY discloses research grants from Medtronic, Medicos Hirata, Termo, Bristal-Myers Squibb, and Otsuka and lecturer’s fees from Boehringer-Ingelheim, Daiichi Sankyo, Otsuka, Bayer, Sanofi, Phizer, Bristal-Myers Squibb, Stryker, Medtronic, and Mitsubishi Tanabe. NS reports research a grant from Termo; lecturer’s fees from Jimro, Otsuka, Johnson & Johnson, Medtronic, Stryker, and Medicos Hirata; and membership of the advisory boards for Medtronic and Jimro. HY discloses research grants from Bristol-Myers Squibb; lecturer’s fees from Bayer, Daiichi-Sankyo, Bristol-Myers Squibb, Boehringer Ingelheim, and Striker; and membership of the advisory boards for Daiichi-Sankyo, Bayer, and Boehringer Ingelheim. KU reports lecturer’s fees from Nihon Medi-Physics. YN reports no disclosures. TM reports a research grant from Nexis; lecturer’s fees from AbbVie, AstraZeneca, Daiichi Sankyo, Kyorin, Mitsubishi Tanabe, and Phizer; manuscript fee from Pfizer; and membership of the advisory boards for Asahi Kasei, Boston Scientific, and Bristal-Myers Squibb.

    • Ethics approval Hyogo College of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data available.