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Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery

Retrospective Analysis of the Tama-REgistry of Acute endovascular Thrombectomy (TREAT)

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Abstract

Background

The efficacy of mechanical thrombectomy in the treatment of occlusions of the second segment of the middle cerebral artery (M2) has not been firmly established.

Methods

This study analyzed data from patients who had undergone mechanical thrombectomy for the first segment of the middle cerebral artery (M1) and M2 occlusion from the Tama-REgistry of Acute endovascular Thrombectomy (TREAT) between January 2015 and March 2017, which is a multicenter database in the Tama area of Tokyo, Japan. The M1 and M2 occlusions were compared in order to evaluate the safety and efficacy of M2 thrombectomy.

Results

A total of 515 patients were registered, whereby 160 patients with M1 occlusion and 51 patients with M2 occlusion were included. While the puncture-to-reperfusion time was longer in the M2 occlusions (median 43 min, range 30–61 min vs. median 60 min, range 38–79 min, p = 0.01), no significant differences were seen in the proportion of patients with successful reperfusion, postoperative hemorrhagic complications and good outcome (modified Rankin scale ≤2 at 90 days). Younger age was the only independent factor associated with good outcome in patients with M2 occlusions as determined by the multivariate analysis (p = 0.033, odds ratio 0.91, 95% confidence interval 0.83–0.99).

Conclusion

The outcome and the safety profile of mechanical thrombectomy for M2 occlusions are favorable and comparable to those of the M1 occlusion thrombectomy.

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Acknowledgements

The TREAT enrolling hospitals, and investigators. Fussa Hospital: Takahisa Fuse. Hino Municipal Hospital: Yoshiaki Kuroshima. Kitahara International Hospital: Hirotaka Yoshida. Kyorin University: Tatsuo Amano, Teruyuki Hirano and Yoshiaki Shiokawa. Musashino Red Cross Hospital: Youhei Sato. National Hospital Organization Disaster Medical Center: Keigo Shigeta. Nippon Medical School Tama Nagayama Hospital: Junya Kaneko. Sassa General Hospital: Atushi Shimada. Showa General Hospital: Akira Saito and Osamu Ishikawa. Tokai University Hachioji Hospital: Masami Shimoda and Shigeru Nogawa. Tokyo Medical University Hachioji Medical Center: Hiroyuki Jimbo and Junya Tsurukiri. Tokyo Metropolitan Tama Medical Center: Takahiro Ota and Masayuki Ueda.

Funding

This study was partially supported by the Japanese Society for Neuroendovascular Therapy.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256, Midori-cho, 190-0014, Tachikawa-shi, Tokyo, Japan

    Tomoyuki Nakano & Keigo Shigeta

  2. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashi-dai, 183-8524, Fuchu-shi, Tokyo, Japan

    Takahiro Ota

  3. Department of Stroke and Cerebrovascular Medicine, Kyorin University, 6-20-2, Shinkawa, 181-8611, Mitaka-shi, Tokyo, Japan

    Tatsuo Amano & Teruyuki Hirano

  4. Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashi-dai, 183-8524, Fuchu-shi, Tokyo, Japan

    Masayuki Ueda

  5. Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, 2-1-1, Amakubo, 305-8576, Tsukuba, Ibaraki, Japan

    Yuji Matsumaru

  6. Department of Neurosurgery, Kyorin University, 6-20-2, Shinkawa, 181-8611, Mitaka-shi, Tokyo, Japan

    Yoshiaki Shiokawa

Authors
  1. Tomoyuki Nakano
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  2. Keigo Shigeta
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  3. Takahiro Ota
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  4. Tatsuo Amano
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  5. Masayuki Ueda
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  6. Yuji Matsumaru
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  7. Yoshiaki Shiokawa
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  8. Teruyuki Hirano
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Corresponding author

Correspondence to Tomoyuki Nakano.

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Conflict of interest

T. Nakano, K. Shigeta, T. Ota, T. Amano and M. Ueda declare that they have no competing interests. Y. Matsumaru received honoraria from Medtronic, Stryker, and Johnson&Johnson. Y. Shiokawa received research grant from AbbVie GK and ONO Pharmmedical Co., LTD. T. Hirano received honoraria from Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Otsuka Pharma, Pfizer, and Sanofi.

Ethical standards

Each hospital provided individual patient data with the approval of their institutional review boards. The study adhered to the ethical principles that have their origin in the Declaration of Helsinki. Informed consent was obtained in the form of opt-out in each hospital.

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Nakano, T., Shigeta, K., Ota, T. et al. Efficacy and Safety of Mechanical Thrombectomy for Occlusion of the Second Segment of the Middle Cerebral Artery. Clin Neuroradiol 30, 481–487 (2020). https://doi.org/10.1007/s00062-019-00810-3

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  • DOI: https://doi.org/10.1007/s00062-019-00810-3

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