You are here

Article Text

Article menu

Download PDFPDF

SNIS 21st annual meeting oral abstracts
O-032 Outcomes of M1 vs M2 thrombectomy for acute ischemic stroke patients with low ASPECTS – an international multicenter investigation
Free
  1. H Chen1,2,
  2. M Colasurdo3,
  3. H Matsukawa4,
  4. C Cunningham4,
  5. I Maier5,
  6. P Jabbour6,
  7. J Kim7,
  8. S Wolfe8,
  9. A Rai9,
  10. R Starke10,
  11. M Psychogios11,
  12. A Shaban12,
  13. N Goyal13,
  14. S Yoshimura14,
  15. H Cuellar15,
  16. B Howard16,
  17. A Alawieh16,
  18. A Alaraj17,
  19. M Ezzeldin18,
  20. D Romano19,
  21. O Tanweer20,
  22. J Mascitelli21,
  23. I Fragata22,
  24. A Polifka23,
  25. F Siddiqui24,
  26. J Osbun25,
  27. R Grandhi26,
  28. R Crosa27,
  29. C Matouk28,
  30. M Park29,
  31. M Levitt30,
  32. W Brinjikji31,
  33. M Moss32,
  34. E Daglioglu33,
  35. R Williamson34,
  36. P Navia35,
  37. R De Leacy36,
  38. S Chowdhry37,
  39. D Altschul38,
  40. A Spiotta4,
  41. P Kan39
  1. 1National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD
  2. 2MedStar Georgetown University Hostpial, Washington, DC
  3. 3Oregon Health and Science University Hospital, Portland, OR
  4. 4Medical University of South Carolina, Charleston, SC
  5. 5Universitätsmedizin Göttingen, University Medicine Goettingen, 37075 Göttingen, Germany
  6. 6Thomas Jefferson University, Philadelphia, PA
  7. 7Chonnam National University Hospital, Gwangju, Korea, Republic Of
  8. 8Wake Forest Baptist Health, Lexington, NC
  9. 9West Virginia University, Morgantown, WV
  10. 10University of Miami Health System, Miami, FL
  11. 11Universitätsspital Basel, Basel, UK
  12. 12University of Iowa, Iowa City, IA
  13. 13University of Tennessee Health Science Center/Semmes Murphey Foundation, National Institutes of Health, Memphis, TN
  14. 14Hyogo College of Medicine, Hyogo, Japan
  15. 15LSU Health Shreveport, Shreveport, LA
  16. 16Emory University, Atlanta, GA
  17. 17University of Illinois at Chicago, Chicago, IL
  18. 18University of Houston, HCA Houston Healthcare Kingwood, Kingwood, TX
  19. 19Aou S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
  20. 20Baylor College of Medicine, Houston, TX
  21. 21University of Texas Health Science Center at San Antonio, San Antonio, TX
  22. 22NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
  23. 23University of Florida, Gainesville, FL
  24. 24University of Michigan Health West, Wyoming, MI
  25. 25Washington University in St. Louis, St. Louis, MO
  26. 26University of Utah, Salt Lake City, UT
  27. 27Médica Uruguaya, Montevideo, Uruguay
  28. 28Yale University, New Haven, CT
  29. 29University of Virginia, Charlottesville, VA
  30. 30University of Washington, Seattle, WA
  31. 31Mayo Clinic Minnesota, Rochester, MN
  32. 32Washington Regional Medical Center, Fayetteville, AR
  33. 33Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey
  34. 34Alleghany Hospital, Pittsburgh, PA
  35. 35Hospital Universitario La Paz, Madrid, Spain
  36. 36Mount Sinai Health System, New York, NY
  37. 37NorthShore University Health System, Evanstaon, IL
  38. 38Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
  39. 39University of Texas Medical Branch at Galveston, Galveston, TX

Abstract

Background Recent landmark trials have demonstrated the efficacy and safety of endovascular thrombectomy (EVT) for stroke patients with proximal large vessel occlusions and large areas of ischemic territory as evidenced by low Alberta Stroke Program Early CT scores (ASPECTS). However, the effectiveness of EVT for low-ASPECTS stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.

Methods We conducted an international multi-center retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry. Patients with isolated M1 or M2 occlusions and low ASPECTS (5 or lower) who underwent successful EVT revascularization from 2013 to 2023 were identified. Patient demographics, medical history, and stroke characteristics were captured. Primary outcome was futile revascularization (90-day modified Rankin scale [mRS] 5 or 6). Secondary outcomes include ordinal 90-day mRS outcomes, acceptable 90-day outcomes (mRS 0–3), intracranial hemorrhage (ICH), and sICH. Multivariable binary and ordinal logistic regression analyses were used to adjust for confounders.

Results 173 patients were included; 138 patients had an M1 occlusion, and 35 patients had an M2 occlusion. Overall, M2 patients experienced higher rates of futile revascularization compared to M1 patients (mRS 5–6, 50.0% vs. 29.9%, respectively; p=0.029). We observed similar rates of ICH (47.1% vs. 40.7%, p=0.51) and sICH (11.8% vs. 8.9%, p=0.61) for M2 and M1 patients, respectively. After multivariable adjustments for age, NIH stroke scale, pre-stroke mRS, treatment time window, ASPECTS, prior intravenous thrombolysis, front-line EVT technique, and ICH, M2 patients had significantly higher odds of futile revascularization compared to M1 patients (OR 5.48 [95%CI 1.91 to 15.7], p=0.002), lower odds of acceptable outcomes (OR 0.33 [95%CI 0.12 to 0.89], p=0.028), and worse 90-day mRS outcomes (common OR 3.05 [95%CI 1.33 to 7.01], p=0.009).

Conclusions EVT for low-ASPECTS M2 occlusions was significantly associated with worse outcomes compared to EVT for low-ASPECTS M1 occlusions, independent of baseline characteristics and ICH. These findings suggest that providers should take caution in extrapolating the positive findings of recent low ASPECTS EVT trials to patients with M2 occlusions.

View this table:
Abstract O-032 Table 1

Treatment outcomes following successful M1 vs. M2 thrombectomy for low ASPECTS patients

Abstract O-032 Figure 1
Abstract O-032 Figure 1

90-day outcomes of low-ASPECTS stroke patients who underwent successful endovascular revascularization of M1 vs. M2 occlusions

Disclosures H. Chen: None. M. Colasurdo: None. H. Matsukawa: None. C. Cunningham: None. I. Maier: None. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: None. M. Psychogios: None. A. Shaban: None. N. Goyal: None. S. Yoshimura: None. H. Cuellar: None. B. Howard: None. A. Alawieh: None. A. Alaraj: None. M. Ezzeldin: None. D. Romano: None. O. Tanweer: None. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: None. R. Crosa: None. C. Matouk: None. M. Park: None. M. Levitt: None. W. Brinjikji: None. M. Moss: None. E. Daglioglu: None. R. Williamson: None. P. Navia: None. R. De Leacy: None. S. Chowdhry: None. D. Altschul: None. A. Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus. P. Kan: 1; C; Medtronic, Siemens, NIH (1U18EB029353–01). 2; C; Imperative Care, Stryker Neurovascular. 4; C; Vena Medical.

https://doi.org/10.1136/jnis-2024-SNIS.32

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.