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Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis
  1. Carlos Pérez-García1,
  2. Santiago Rosati1,
  3. Carlos Gómez-Escalonilla2,
  4. Juan Arrazola3,
  5. Alfonso López-Frías1,
  6. Eva González4,
  7. Jon Fondevila4,
  8. Pedro Vega5,
  9. Eduardo Murias5,
  10. Elvira Jimenez-Gomez6,
  11. Isabel Bravo Rey6,
  12. Juan Macho7,
  13. Luis San Roman7,
  14. Isabel Rodriguez Caamaño8,
  15. Andres Julián Paipa9,
  16. Sebastian Remollo10,
  17. Yeray Aguilar Tejedor11,
  18. Isabel Bermúdez-Coronel12,
  19. Sarai Moliner13,
  20. José Manuel Pumar14,
  21. Saima Bashir15,
  22. Josep Puig16,
  23. Antonio López-Rueda7,
  24. Jordi Blasco7,
  25. Raul G Nogueira17,
  26. Manuel Moreu1
  1. 1Interventional Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
  2. 2Neurology, Hospital Clínico San Carlos, Madrid, Spain
  3. 3Radiology, Hospital Clínico San Carlos, Madrid, Spain
  4. 4Interventional Neuroradiology, Hospital Universitario de Cruces, Bilbao, Spain
  5. 5Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain
  6. 6Interventional Neuroradiology, Hospital Universitario Reina Sofía, Cordoba, Spain
  7. 7Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
  8. 8Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
  9. 9Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
  10. 10Interventional Neuroradiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  11. 11Interventional Radiology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
  12. 12Interventional Neuroradiology, Hospital Ramón y Cajal, Madrid, Spain
  13. 13Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
  14. 14Interventional Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  15. 15Neurology, University Hospital Dr Josep Trueta, Girona, Spain
  16. 16Radiology, University Hospital Dr Josep Trueta, Girona, Spain
  17. 17Neurology and Interventional Radiology, Grady Memorial Hospital, Chickasha, Oklahoma, USA
  1. Correspondence to Dr Santiago Rosati, Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Madrid, Spain; santiagorosati{at}hotmail.com

Abstract

Background The optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT.

Methods Patients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0–2.

Results 214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0–2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months.

Conclusions As front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.

  • stroke
  • thrombectomy
  • technique
  • device
  • catheter

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @Sremollo, @AntonioLR81, @manumoreu

  • Contributors Protocol/project development: CPG, MM, SR, CGE, ALF. Interventional procedure performance: CPG, SR, CGE, ALF, JF, PV, EM, EJG, IBR, JMM, LSR, IRC, AJP, SR, YAT, IBC, SM, JMP, SB, JP, ALR, JB, RN, MM. Data collection and management: CPG, SR, CGE, JA, ALF, EG, JF, PV, EM, EJG, IBR, JMM, LSR, IRC, AJP, SR, YAT, IBC, SM, JMP, SB, JP, ALR, JB, RN, MM. Manuscript writing/editing: CPG, MM, JB, JP, RN. Revising the work critically for important intellectual content: CPG, SR, CGE, JA, ALF, EG, JF, PV, EM, EJG, IBR, JMM, LSR, IRC, AJP, SR, YAT, IBC, SM, JMP, SB, JP, ALR, JB, RN, MM. Manuscript final approval: CPG, SR, CGE, JA, ALF, EG, JF, PV, EM, EJG, IBR, JMM, LSR, IRC, AJP, SR, YAT, IBC, SM, JMP, SB, JP, ALR, JB, RN, MM. Agreement to be accountable for all aspects of the work: CPG, SR, CGE, JA, ALF, EG, JF, PV, EM, EJG, IBR, JMM, LSR, IRC, AJP, SR, YAT, IBC, SM, JMP, SB, JP, ALR, JB, RN, MM. Guarantor: CPG.

  • 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.

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