Introduction: Acute ischemic stroke remains a devastating disease that portends a high rate of morbidity and early mortality without intervention. Although significant advances have been made with tissue plasminogen activator and mechanical thrombectomy in M1 occlusions, the effect in patients with M2 occlusions is poorly understood. The aim of this study is to determine if M2 revascularization is associated with improved functional outcome and severity of stroke.
Hypothesis: We hypothesize that endovascular therapy in patients with M2 occlusions will portend better functional outcomes and improvement in severity of stroke.
Methods: We generated a retrospective database of stroke patients who received endovascular intervention over a 5-year period. We identified suspected M2 occlusions on CT angiography and confirmed these findings with cerebral angiograms. Demographic information, including age, sex, side of occlusion, as well as functional outcome and stroke severity were assessed via initial and discharge modified Rankin (mRS) and National Institutes of Health Stroke Scale (NIHSS).
Results: We identified 224 patients who received endovascular intervention at our institution over the study period. From this group, 53 candidates with suspected M2 occlusions on initial CT angiography were identified, of which 36 patients (15 female, 21 male) were confirmed to have M2 occlusions on cerebral angiogram. The average age for patients was 71.0 (female= 72.9 ± 14.6; male= 69.7 ± 14.1). NIHSS showed dramatic improvement from admission to discharge, while mRS showed mild-to-moderate benefits (Table 1).
Conclusion: Endovascular therapy in M2 occlusions showed marked improvement in severity of stroke symptoms and mild benefits in functional outcome. Although further studies will be needed to analyze the magnitude of this effect, endovascular therapy does seem to be a useful intervention to improve the functional outcome and severity of stroke in M2 patients.