RT Journal Article SR Electronic T1 Mechanical thrombectomy beyond the circle of Willis: efficacy and safety of different techniques for M2 occlusions JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 546 OP 550 DO 10.1136/neurintsurg-2021-017425 VO 14 IS 6 A1 Leonardo Renieri A1 Iacopo Valente A1 Adam A Dmytriw A1 Ajit S Puri A1 Jasmeet Singh A1 Sergio Nappini A1 Patrizia Nencini A1 Artem Kaliaev A1 Mohamad Abdalkader A1 Andrea Alexandre A1 Giuseppe Garignano A1 Sheela Vivekanandan A1 Reginald P Fong A1 Carmen Parra-Fariñas A1 Julian Spears A1 Santiago Gomez-Paz A1 Christopher Ogilvy A1 Robert W Regenhardt A1 Naif Alotaibi A1 André Beer-Furlan A1 Krishna C Joshi A1 Melanie Walker A1 Juan Vicenty-Padilla A1 Jean Darcourt A1 Paul Foreman A1 Anna L Kuhn A1 Thanh N Nguyen A1 Christoph J Griessenauer A1 Thomas R Marotta A1 Ajith Thomas A1 Aman B Patel A1 Thabele M Leslie-Mazwi A1 Michael Chen A1 Michael R Levitt A1 Karen Chen A1 Christophe Cognard A1 Alessandro Pedicelli A1 Nicola Limbucci YR 2022 UL http://jnis.bmj.com/content/14/6/546.abstract AB Background M2 segment occlusions represent approximately one-third of non-lacunar ischemic stroke and can lead to permanent neurological deficits. Various techniques are available for mechanical thrombectomy beyond the circle of Willis, but data evaluating their effectiveness and safety are lacking.Methods A retrospective review of patients with ischemic stroke undergoing mechanical thrombectomy for M2 occlusions from 13 centers in North American and Europe was performed. Tandem or multiple-territory occlusions were excluded. The primary outcome was 90-day modified Rankin Scale and reperfusion rates across stent-retriever, direct aspiration and combined techniques.Results There were 465 patients (mean age 71.48±14.03 years, 53.1% female) with M2 occlusions who underwent mechanical thrombectomy. Stent-retriever alone was used in 133 (28.6%), direct aspiration alone in 93 (20.0%) and the combined technique in 239 (51.4%) patients. Successful reperfusion was achieved with the combined technique in 198 (82.2%; OR 2.6 (1.1–6.9)), with stent-retriever alone in 112 (84.2%; OR 9.2 (1.9–44.6)) and with direct aspiration alone in 62 (66.7%; referencecategory). Intraprocedural subarachnoid hemorrhages (iSAH) were 36 (7.7%) and were more likely to occur in patients treated with the stent-retrievers (OR 5.0 (1.1–24.3)) and combined technique (OR 4.6 (1.1–20.9)). Good clinical outcome was achieved in 260 (61.8%) patients, while 59 (14.0%) patients died. Older age, higher baseline NIHSS (National Institutes of Health Stroke Scale), parenchymal hemorrhage and iSAH were associated with poor outcome while successful recanalization and higher baseline ASPECTS (Alberta Stroke Program Early CT Score) were associated with good outcome. No differences were found among the three techniques in terms of clinical outcome.Conclusion Stent-retrievers and a combined approach for M2 occlusions seem more effective than direct aspiration, but with higher rates of iSAH. This leads to no detectable difference in clinical outcome at 3 months.Data are available upon reasonable request.