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.
Data availability statement
Data are available upon reasonable request.
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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.
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