PT  - JOURNAL ARTICLE
AU  - F. Bala
AU  - B.J. Kim
AU  - M. Najm
AU  - J. Thornton
AU  - E. Fainardi
AU  - P. Michel
AU  - K. Alpay
AU  - D. Herlihy
AU  - M. Goyal
AU  - I. Casetta
AU  - S. Nannoni
AU  - P. Ylikotila
AU  - S. Power
AU  - V. Saia
AU  - A. Hegarty
AU  - G. Pracucci
AU  - R. Rautio
AU  - A. Ademola
AU  - A. Demchuk
AU  - S. Mangiafico
AU  - K. Boyle
AU  - M.D. Hill
AU  - D. Toni
AU  - S. Murphy
AU  - B.K. Menon
AU  - M.A. Almekhlafi
AU  - for the Selection of Late-window Stroke for Thrombectomy by Imaging Collateral Extent (SOLSTICE) Consortium
TI  - Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window
AID  - 10.3174/ajnr.A7833
DP  - 2023 Mar 23
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2023/03/23/ajnr.A7833.short
4100  - http://www.ajnr.org/content/early/2023/03/23/ajnr.A7833.full
AB  - BACKGROUND AND PURPOSE: Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6–24 hours after symptom onset.MATERIALS AND METHODS: Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6–24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b–3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion.RESULTS: Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25–3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, P = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11–7.29).CONCLUSIONS: In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.eTICIexpanded thrombolysis in cerebral infarctionIQRinterquartile rangeSICHsymptomatic intracranial hemorrhage