Efficacy of Mechanical Thrombectomy Using an Aspiration Catheter Compared with a Stent Retriever Alone for Middle Cerebral Artery M2 Occlusion

Overview

Journal J Neuroendovasc Ther

Specialty Neurology

Date 2023 Jul 28

PMID 37502667

Authors

Hidekazu Yamazaki

Masafumi Morimoto

Chiyoe Hikita

Mitsuhiro Iwasaki

Masahiro Maeda

Yasufumi Inaka

Shinya Fukuta

Hiroaki Sato

Affiliations

Soon will be listed here.

Abstract

Objective: Mechanical thrombectomy (MT) for middle cerebral artery M2 occlusion (M2O) is challenging because the procedure is performed in a narrow and tortuous artery. In this study, we compared MT using an aspiration catheter (AC) versus a stent retriever (SR) used alone, and retrospectively evaluated the efficacy and safety of MT using an AC for M2O.

Methods: Seventy-four consecutive patients who underwent MT for M2O at our institution between April 2016 and April 2020 were evaluated. The subjects were classified into those treated by AC (AC group) or SR alone (SR group). The AC group included patients treated by both contact aspiration and a combination technique of AC and SR. Background factors and outcomes, including modified treatment in cerebral infarction (mTICI) 2c-3 recanalization, were compared between the groups.

Results: AC and SR groups consisted of 47 and 27 patients respectively. Among them, the rate of mTICI 2b-3 was 93.6% vs 92.6%, and that of mTICI 2c-3 was 72.3% vs 48.2% (P = 0.004). The perioperative symptomatic subarachnoid hemorrhage (SAH) rate was 0% vs 7.4%, and modified Rankin scale scores of 0-2 were 78.6% vs 50% (P = 0.03). In the AC group, the mTICI 2c-3 rate was higher in patients in whom the AC was adequately advanced to the thrombus compared to those with inadequate AC advancement (83.3% vs 36.3%, P = 0.002).

Conclusion: The rate of mTICI 2c-3 was higher in the AC than SR group, with no cases of symptomatic SAH. MT using AC for M2O might achieve safe and effective thrombectomy.

References

Goyal M, Fargen K, Turk A, Mocco J, Liebeskind D, Frei D . 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerv Surg. 2013; 6(2):83-6. PMC: 4156591. DOI: 10.1136/neurintsurg-2013-010665. View

Kaesmacher J, Maegerlein C, Zibold F, Wunderlich S, Zimmer C, Friedrich B . Improving mTICI2b reperfusion to mTICI2c/3 reperfusions: A retrospective observational study assessing technical feasibility, safety and clinical efficacy. Eur Radiol. 2017; 28(1):274-282. DOI: 10.1007/s00330-017-4928-3. View

Sarraj A, Sangha N, Hussain M, Wisco D, Vora N, Elijovich L . Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment. JAMA Neurol. 2016; 73(11):1291-1296. DOI: 10.1001/jamaneurol.2016.2773. View

Saver J, Goyal M, van der Lugt A, Menon B, Majoie C, Dippel D . Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016; 316(12):1279-88. DOI: 10.1001/jama.2016.13647. View

DeGraba T, Hallenbeck J, Pettigrew K, Dutka A, Kelly B . Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials. Stroke. 1999; 30(6):1208-12. DOI: 10.1161/01.str.30.6.1208. View

Miura M, Yoshimura S, Sakai N, Yamagami H, Uchida K, Nagao Y . Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2. J Neurointerv Surg. 2019; 11(10):964-969. DOI: 10.1136/neurintsurg-2018-014627. View

Kuhn A, Wakhloo A, Diego Lozano J, Massari F, de Macedo Rodrigues K, Marosfoi M . Two-year single-center experience with the 'Baby Trevo' stent retriever for mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2016; 9(6):541-546. DOI: 10.1136/neurintsurg-2016-012454. View

Grieb D, Schlunz-Hendann M, Brinjikji W, Melber K, Greling B, Lanfermann H . Mechanical thrombectomy of M2 occlusions with distal access catheters using ADAPT. J Neuroradiol. 2019; 46(4):231-237. DOI: 10.1016/j.neurad.2019.01.096. View

Seners P, Turc G, Naggara O, Henon H, Piotin M, Arquizan C . Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy: Incidence, Predictors, and Prediction Scores. Stroke. 2019; 49(12):2975–2982. DOI: 10.1161/STROKEAHA.118.022335. View

10.

Menon B, Hill M, Davalos A, Roos Y, Campbell B, Dippel D . Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions: meta-analysis of data from the HERMES Collaboration. J Neurointerv Surg. 2019; 11(11):1065-1069. DOI: 10.1136/neurintsurg-2018-014678. View

11.

Altenbernd J, Kuhnt O, Hennigs S, Hilker R, Loehr C . Frontline ADAPT therapy to treat patients with symptomatic M2 and M3 occlusions in acute ischemic stroke: initial experience with the Penumbra ACE and 3MAX reperfusion system. J Neurointerv Surg. 2017; 10(5):434-439. PMC: 5909737. DOI: 10.1136/neurintsurg-2017-013233. View

12.

Haussen D, Al-Bayati A, Eby B, Ravindran K, Rodrigues G, Frankel M . Blind exchange with mini-pinning technique for distal occlusion thrombectomy. J Neurointerv Surg. 2019; 12(4):392-395. DOI: 10.1136/neurintsurg-2019-015205. View

13.

Ng P, Larson T, Nichols C, Murray M, Salzman K, Smith R . Intraprocedural predictors of post-stent retriever thrombectomy subarachnoid hemorrhage in middle cerebral artery stroke. J Neurointerv Surg. 2018; 11(2):127-132. DOI: 10.1136/neurintsurg-2018-013873. View

14.

Barchetti G, Cagnazzo F, Raz E, Barbagallo G, Toccaceli G, Peschillo S . Mechanical Thrombectomy of Distal Occlusions Using a Direct Aspiration First Pass Technique Compared with New Generation of Mini-0.017 Microcatheter Compatible-Stent Retrievers: A Meta-Analysis. World Neurosurg. 2019; 134:111-119. DOI: 10.1016/j.wneu.2019.10.030. View