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Ischemic stroke
Original research
Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis
  1. Andrea M Alexandre1,
  2. Francesca Colò2,
  3. Valerio Brunetti3,
  4. Iacopo Valente1,
  5. Giovanni Frisullo3,
  6. Alessandro Pedicelli1,
  7. Luca Scarcia2,
  8. Claudia Rollo2,
  9. Anne Falcou4,
  10. Luca Milonia5,
  11. Marco Andrighetti4,
  12. Mariangela Piano6,
  13. Antonio Macera6,
  14. Christian Commodaro7,
  15. Maria Ruggiero7,
  16. Valerio Da Ros8,
  17. Luigi Bellini8,
  18. Guido A Lazzarotti9,
  19. Mirco Cosottini9,
  20. Armando A Caragliano10,
  21. Sergio L Vinci10,
  22. Joseph D Gabrieli11,
  23. Francesco Causin11,
  24. Pietro Panni12,
  25. Luisa Roveri13,
  26. Nicola Limbucci14,
  27. Francesco Arba15,
  28. Marco Pileggi16,
  29. Giovanni Bianco17,
  30. Daniele G Romano18,
  31. Francesco Diana18,
  32. Vittorio Semeraro19,
  33. Nicola Burdi19,
  34. Maria P Ganimede20,
  35. Emilio Lozupone21,
  36. Antonio Fasano22,
  37. Elvis Lafe23,
  38. Anna Cavallini24,
  39. Riccardo Russo25,
  40. Mauro Bergui25,
  41. Paolo Calabresi2,3,
  42. Giacomo Della Marca2,3,
  43. Aldobrando Broccolini2,3
  1. 1 Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2 Catholic University School of Medicine, Rome, Italy
  3. 3 Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4 Stroke Unit, University Hospital Policlinico Umberto I, Rome, Italy
  5. 5 Interventional Neuroradiology, University Hospital Policlinico Umberto I, Rome, Italy
  6. 6 Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  7. 7 Neuroradiology Unit, AUSL Romagna, Cesena, Italy
  8. 8 Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, Rome, Italy
  9. 9 Neuroradiology Unit, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
  10. 10 Neuroradiology Unit, AOU Policlinico G. Martino, Messina, Italy
  11. 11 Neuroradiology Unit, Policlinico Universitario di Padova, Padia, Italy
  12. 12 Interventional Neuroradiology Unit, IRCCS San Raffaele University Hospital, Milan, Italy
  13. 13 Neurology Unit, IRCCS San Raffaele University Hospital, Milan, Italy
  14. 14 Interventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy
  15. 15 Stroke Unit, A.O.U. Careggi, Florence, Italy
  16. 16 Neuroradiology Unit, Neurocenter of Southern Switzerland-EOC, Lugano, Switzerland
  17. 17 Stroke Center, Neurocenter of Southern Switzerland-EOC, Lugano, Switzerland
  18. 18 Neuroradiology Unit, AOU S Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
  19. 19 Interventional Radiology Unit, "SS Annunziata" Hospital, Taranto, Italy
  20. 20 Neuroradiology Unit, "SS Annunziata" Hospital, Taranto, Italy
  21. 21 Neuroradiology Unit, Vito Fazzi Hospital, Lecce, Italy
  22. 22 Neurology Unit, Vito Fazzi Hospital, Lecce, Italy
  23. 23 Neuroradiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
  24. 24 Cerebrovascular Diseases Unit, IRCCS Fondazione Mondino, Pavia, Italy
  25. 25 Neuroradiology Unit, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
  1. Correspondence to Dr Aldobrando Broccolini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; aldobrando.broccolini{at}policlinicogemelli.it

Abstract

Background The purpose of this study was to evaluate the effectiveness of mechanical thrombectomy (MT) in patients with isolated M2 occlusion and minor symptoms and identify possible baseline predictors of clinical outcome.

Methods The databases of 16 high-volume stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score ≤5 who received either early MT (eMT) or best medical management (BMM) with the possibility of rescue MT (rMT) on early neurological worsening. Because our patients were not randomized, we used propensity score matching (PSM) to estimate the treatment effect of eMT compared with the BMM/rMT. The primary clinical outcome measure was a 90-day modified Rankin Scale score of 0–1.

Results 388 patients were initially selected and, after PSM, 100 pairs of patients receiving eMT or BMM/rMT were available for analysis. We found no significant differences in clinical outcome and in safety measures between patients receiving eMT or BMM/rMT. Similar results were also observed after comparison between eMT and rMT. Concerning baseline predicting factors of outcome, the involvement of the M2 inferior branch was associated with a favorable outcome.

Conclusion Our multicenter retrospective analysis has shown no benefit of eMT in minor stroke patients with isolated M2 occlusion over a more conservative therapeutic approach. Although our results must be viewed with caution, in these patients it appears reasonable to consider BMM as the first option and rMT in the presence of early neurological deterioration.

  • stroke
  • thrombectomy
  • thrombolysis

Data availability statement

Data are available upon reasonable request.

http://dx.doi.org/10.1136/jnis-2022-019557

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @abroccolini1

    • Contributors AMA, FC, VB, IV, GDM and AB contributed to study concept or design, acquisition, analysis and interpretation of data and drafting/revision of the manuscript for content. GF, AP, LS, CR, CRo, AF, LM, MA, MP, AM, CC, MR, VDR, LB, GAL, MC, AAC, SLV, JDG, FCa, PP, LR, NL, FA, MPi, GB, DGR, FD, VS, NS, NB, MPG, ELo, AF, ELa, AC, RR and MB contributed to the acquisition, analysis and interpretation of data and revision of the manuscript for content. PC contributed to study concept or design and to drafting/revision of the manuscript for content. AB is the author acting as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.