Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits.

Dobrocky, Tomas; Piechowiak, Eike I.; Volbers, Bastian; Slavova, Nedelina; Kaesmacher, Johannes; Meinel, Thomas R.; Arnold, Marcel; Fischer, Urs; Jung, Simon; Gralla, Jan; Mordasini, Pasquale; Heldner, Mirjam R. (2021). Treatment and Outcome in Stroke Patients With Acute M2 Occlusion and Minor Neurological Deficits. Stroke, 52(3), pp. 802-810. American Heart Association 10.1161/STROKEAHA.120.031672

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BACKGROUND AND PURPOSE

Treatment in stroke patients with M2 segment occlusion of the middle cerebral artery presenting with mild neurological deficits is a matter of debate. The main purpose was to compare the outcome in patients with a minor stroke and a M2 occlusion.

METHODS

Consecutive intravenous thrombolysis (IVT) eligible patients admitted to the Bernese stroke center between January 2005 and January 2020 with acute occlusion of the M2 segment and National Institutes of Health Stroke Scale score ≤5 were included. Outcome was compared between IVT only versus endovascular therapy (EVT) including intra-arterial thrombolysis and mechanical thrombectomy (MT; ±IVT) and between IVT only versus MT only.

RESULTS

Among 169 patients (38.5% women, median age 70.2 years), 84 (49.7%) received IVT only and 85 (50.3%) EVT (±IVT), the latter including 39 (45.9%) treated with MT only. Groups were similar in sex, age, vascular risk factors, event cause, or preevent independency. Compared with IVT only, there was no difference in favorable outcome (modified Rankin Scale score, 0-2) for EVT (adjusted odds ratio, 0.96; adjusted P=0.935) or for MT only (adjusted odds ratio, 1.12; adjusted P=0.547) groups. Considering only patients treated after 2015, there was a significantly better 3-month modified Rankin Scale shift (adjusted P=0.032) in the EVT compared with the IVT only group.

CONCLUSIONS

Our study demonstrates similar effectiveness of IVT only versus EVT (±IVT), and of IVT only versus MT only in patients with peripheral middle cerebral artery occlusions and minor neurological deficits and indicates a possible benefit of EVT considering only patients treated after 2015. There is an unmet need for randomized controlled trials in this stroke field, including imaging parameters, and more sophisticated evaluation of National Institutes of Health Stroke Scale score subitems, neurocognition, and quality of life neglected by the standard outcome scales such as modified Rankin Scale and National Institutes of Health Stroke Scale score.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Dobrocky, Tomas; Piechowiak, Eike Immo; Volbers, Bastian; Slavova, Nedelina Bozhidarova; Kaesmacher, Johannes; Meinel, Thomas Raphael; Arnold, Marcel; Fischer, Urs; Jung, Simon; Gralla, Jan; Mordasini, Pasquale and Heldner, Mirjam Rachel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4628

Publisher:

American Heart Association

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

03 Feb 2021 10:59

Last Modified:

24 Feb 2021 09:55

Publisher DOI:

10.1161/STROKEAHA.120.031672

PubMed ID:

33494637

Uncontrolled Keywords:

National Institutes of Health middle cerebral artery quality of life risk factors thrombectomy

BORIS DOI:

10.48350/151621

URI:

https://boris.unibe.ch/id/eprint/151621

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