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Endovascular clot retrieval for M2 segment middle cerebral artery occlusion: a systematic review and meta‐analysis
Author(s) -
Findakly Salam,
Maingard Julian,
Phan Kevin,
Barras Christen D.,
Jhamb Ashu,
Chandra Ronil,
Thijs Vincent,
Brooks Mark,
Asadi Hamed
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14333
Subject(s) - medicine , modified rankin scale , middle cerebral artery , occlusion , confidence interval , meta analysis , stroke (engine) , solitaire cryptographic algorithm , randomized controlled trial , surgery , mortality rate , ischemia , ischemic stroke , mechanical engineering , engineering
Background Endovascular clot retrieval (ECR) is the standard of care for acute ischaemic stroke due to large vessel occlusion. However, isolated occlusion of the M2 segment of the middle cerebral artery (MCA) was underrepresented in the landmark trials. Aims Given the potential treatment benefit associated with M2 MCA occlusions, we aimed to evaluate the outcome of patients undergoing ECR for M2 occlusion. Methods We conducted a systematic review and meta‐analysis of the available literature that included patients with M2 MCA occlusions who underwent ECR. Successful reperfusion was defined as a treatment in cerebral ischaemia score of 2b‐3. Good outcome was defined as a modified Rankin Scale score ≤ 2. We also analysed complications such as post‐procedure symptomatic intracranial haemorrhage and mortality at 3 months. Results Fifteen studies including 1105 patients with isolated M2 occlusions were analysed. Successful reperfusion occurred in 75.4% (95% confidence interval (CI) 67.7–84.1%) of patients; good outcome was observed in 58.3% (95% CI 51.7–63.8% of patients. The rate of symptomatic intracranial haemorrhage was 5.1% (95% CI 4.2–8.3%), and 3‐month mortality rate was 12.2% (95% CI 10.4–16.3%). Conclusion The outcomes of ECR treatment of M2 occlusions are favourable, with good safety profile. Comparison to medical management from large registries or randomised controlled trials is warranted.