RT Journal Article
SR Electronic
T1 Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 355
OP 363
DO 10.1136/neurintsurg-2021-018560
VO 15
IS 4
A1 Nerea Arrarte Terreros
A1 Agnetha A E Bruggeman
A1 Henk van Voorst
A1 Praneeta R Konduri
A1 Ivo G H Jansen
A1 Manon Kappelhof
A1 Manon L Tolhuisen
A1 Nikki Boodt
A1 Diederik W J Dippel
A1 Aad van der Lugt
A1 Wim H van Zwam
A1 Robert J van Oostenbrugge
A1 H. Bart van der Worp
A1 Bart J Emmer
A1 Frederick J A Meijer
A1 Yvo B W E M Roos
A1 Ed van Bavel
A1 Henk A Marquering
A1 Charles B L M Majoie
A1 ,
YR 2023
UL http://jnis.bmj.com/content/15/4/355.abstract
AB Background A thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval.Objective To investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes.Methods Occlusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSSFU] score, change in NIHSS scores between 24 and 48 hours and baseline ∆[NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns.Results We identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSSFU scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in ∆NIHSS or in 90-day mRS scores.Conclusions In our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.All data relevant to the study are included in the article or uploaded as supplementary information. Source data for this study are not available due to privacy regulations, but analysis methods, codes, and results are available from the corresponding author upon reasonable request.