Publication

Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke

MR CLEAN Registry Investigators, Feb-2019, In : Stroke. 50, 2, p. 419-427 9 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

MR CLEAN Registry Investigators (2019). Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke. Stroke, 50(2), 419-427. https://doi.org/10.1161/STROKEAHA.118.023117

Author

MR CLEAN Registry Investigators. / Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke. In: Stroke. 2019 ; Vol. 50, No. 2. pp. 419-427.

Harvard

MR CLEAN Registry Investigators 2019, 'Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke', Stroke, vol. 50, no. 2, pp. 419-427. https://doi.org/10.1161/STROKEAHA.118.023117

Standard

Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke. / MR CLEAN Registry Investigators.

In: Stroke, Vol. 50, No. 2, 02.2019, p. 419-427.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

MR CLEAN Registry Investigators. Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke. Stroke. 2019 Feb;50(2):419-427. https://doi.org/10.1161/STROKEAHA.118.023117


BibTeX

@article{f63f22a42d0b4d1eadba413d593e5ced,
title = "Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke",
abstract = "Background and Purpose-It is unclear whether endovascular treatment (EVT) is beneficial for patients with acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery. We aimed to compare functional outcomes, technical aspects, and complications of EVT between patients with acute ischemic stroke because of M2 and M1 occlusions in clinical practice. Furthermore, outcome and complications after EVT in dominant and nondominant caliber M2 division occlusions were studied.Methods-Data were obtained from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) which is an ongoing observational study in 16 Dutch centers performing EVT in the Netherlands. Functional outcome was measured with the modified Rankin Scale score at 90 days. Neurological recovery (delta National Institutes of Health Stroke Scale), successful reperfusion rates (extended Thrombolysis in Cerebral Infarction >= 2B), and safety outcomes were also investigated. Associations between occlusion location and outcome were analyzed with ordinal logistic regression models, with adjustment for other prognostic factors.Results-In total, 244 (24{\%}) patients with an M2 and 759 (76{\%}) patients with an M1 occlusion who underwent EVT were analyzed. Functional outcomes were not significantly different between patients with M2 versus M1 occlusions (adjusted common odds ratio, 1.24; 95{\%} CI, 0.87-1.73). Occurrence of symptomatic intracerebral hemorrhage was also similar for M2 and M1 occlusions (6.6{\%} versus 5.9{\%}; P=0.84). Further analysis about dominance of an M2 branch was performed in 175 (72{\%}) patients. Neurological recovery was comparable (mean delta National Institutes of Health Stroke Scale, -2 +/- 10 for dominant M2, -5 +/- 5 for nondominant M2, and -4 +/- 9 [P=0.24] for M1 occlusions). Furthermore, the effect of reperfusion status on functional outcome was comparable between occlusion divisions (common odds ratio, 1.27; 95{\%} CI, 1.06-1.53 for dominant M2; common odds ratio, 1.32; 95{\%} CI, 0.93-1.87 for nondominant M2; and common odds ratio, 1.35; 95{\%} CI, 1.24-1.46 for M1 occlusions).Conclusions-Outcomes and complication rates after EVT were similar in patients with M2 and M1 occlusions. Although based on observational data and a limited sample size, a similar association of reperfusion status with functional outcome for all subgroups provides no evidence that patients with either a dominant or a nondominant M2 occlusion should be routinely excluded from EVT.",
keywords = "middle cerebral artery, reperfusion, stroke, thrombectomy, treatment outcome, MIDDLE CEREBRAL-ARTERY, MECHANICAL THROMBECTOMY, ANGIOGRAPHY, OUTCOMES, SCORE, THERAPY, M1",
author = "{MR CLEAN Registry Investigators} and Compagne, {Kars C. J.} and {van der Sluijs}, {Pieter M.} and {van den Wijngaard}, {Ido R.} and Bob Roozenbeek and Mulder, {Maxim J. H. L.} and {van Zwam}, {Wim H.} and Emmer, {Bart J.} and Majoie, {Charles B. L. M.} and Yoo, {Albert J.} and Nijeholt, {Geert J. Lycklama A.} and Lingsma, {Hester F.} and Dippel, {Diederik W. J.} and {van der Lugt}, Aad and {van Es}, {Adriaan C. G. M.} and Roos, {Yvo B. W. E. M.} and {van Oostenbrugge}, {Robert J.} and Jelis Boiten and Vos, {Jan Albert} and Jansen, {Ivo G. H.} and Mulder, {Maxim J. H. L.} and Goldhoorn, {Robert-Jan B.} and Schonewille, {Wouter J.} and Vos, {Jan Albert} and Majoie, {Charles B. L. M.} and Coutinho, {Jonathan M.} and Wermer, {Marieke J. H.} and {van Walderveen}, {Marianne A. A.} and Julie Staals and {van Zwam}, {Wim H.} and Jeannette Hofmeijer and Martens, {Jasper M.} and Nijeholt, {Geert J. Lycklama A.} and Jelis Boiten and Bob Roozenbeek and Emmer, {Bart J.} and {de Bruijn}, {Sebastiaan F.} and {van Dijk}, {Lukas C.} and {van der Worp}, {H. Bart} and Lo, {Rob H.} and {van Dijk}, {Ewoud J.} and Boogaarts, {Hieronymus D.} and {de Kort}, {Paul L. M.} and Peluso, {Jo J. P.} and {van den Berg}, {Jan S. P.} and {van Hasselt}, {Boudewijn A. A. M.} and Aerden, {Leo A. M.} and Dallinga, {Rene J.} and Maarten Uyttenboogaart and Boers, {Anna M. M.} and Groot, {P. F. C.}",
year = "2019",
month = "2",
doi = "10.1161/STROKEAHA.118.023117",
language = "English",
volume = "50",
pages = "419--427",
journal = "Stroke",
issn = "0039-2499",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "2",

}

RIS

TY - JOUR

T1 - Endovascular Treatment The Role of Dominant Caliber M2 Segment Occlusion in Ischemic Stroke

AU - MR CLEAN Registry Investigators

AU - Compagne, Kars C. J.

AU - van der Sluijs, Pieter M.

AU - van den Wijngaard, Ido R.

AU - Roozenbeek, Bob

AU - Mulder, Maxim J. H. L.

AU - van Zwam, Wim H.

AU - Emmer, Bart J.

AU - Majoie, Charles B. L. M.

AU - Yoo, Albert J.

AU - Nijeholt, Geert J. Lycklama A.

AU - Lingsma, Hester F.

AU - Dippel, Diederik W. J.

AU - van der Lugt, Aad

AU - van Es, Adriaan C. G. M.

AU - Roos, Yvo B. W. E. M.

AU - van Oostenbrugge, Robert J.

AU - Boiten, Jelis

AU - Vos, Jan Albert

AU - Jansen, Ivo G. H.

AU - Mulder, Maxim J. H. L.

AU - Goldhoorn, Robert-Jan B.

AU - Schonewille, Wouter J.

AU - Vos, Jan Albert

AU - Majoie, Charles B. L. M.

AU - Coutinho, Jonathan M.

AU - Wermer, Marieke J. H.

AU - van Walderveen, Marianne A. A.

AU - Staals, Julie

AU - van Zwam, Wim H.

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - Nijeholt, Geert J. Lycklama A.

AU - Boiten, Jelis

AU - Roozenbeek, Bob

AU - Emmer, Bart J.

AU - de Bruijn, Sebastiaan F.

AU - van Dijk, Lukas C.

AU - van der Worp, H. Bart

AU - Lo, Rob H.

AU - van Dijk, Ewoud J.

AU - Boogaarts, Hieronymus D.

AU - de Kort, Paul L. M.

AU - Peluso, Jo J. P.

AU - van den Berg, Jan S. P.

AU - van Hasselt, Boudewijn A. A. M.

AU - Aerden, Leo A. M.

AU - Dallinga, Rene J.

AU - Uyttenboogaart, Maarten

AU - Boers, Anna M. M.

AU - Groot, P. F. C.

PY - 2019/2

Y1 - 2019/2

N2 - Background and Purpose-It is unclear whether endovascular treatment (EVT) is beneficial for patients with acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery. We aimed to compare functional outcomes, technical aspects, and complications of EVT between patients with acute ischemic stroke because of M2 and M1 occlusions in clinical practice. Furthermore, outcome and complications after EVT in dominant and nondominant caliber M2 division occlusions were studied.Methods-Data were obtained from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) which is an ongoing observational study in 16 Dutch centers performing EVT in the Netherlands. Functional outcome was measured with the modified Rankin Scale score at 90 days. Neurological recovery (delta National Institutes of Health Stroke Scale), successful reperfusion rates (extended Thrombolysis in Cerebral Infarction >= 2B), and safety outcomes were also investigated. Associations between occlusion location and outcome were analyzed with ordinal logistic regression models, with adjustment for other prognostic factors.Results-In total, 244 (24%) patients with an M2 and 759 (76%) patients with an M1 occlusion who underwent EVT were analyzed. Functional outcomes were not significantly different between patients with M2 versus M1 occlusions (adjusted common odds ratio, 1.24; 95% CI, 0.87-1.73). Occurrence of symptomatic intracerebral hemorrhage was also similar for M2 and M1 occlusions (6.6% versus 5.9%; P=0.84). Further analysis about dominance of an M2 branch was performed in 175 (72%) patients. Neurological recovery was comparable (mean delta National Institutes of Health Stroke Scale, -2 +/- 10 for dominant M2, -5 +/- 5 for nondominant M2, and -4 +/- 9 [P=0.24] for M1 occlusions). Furthermore, the effect of reperfusion status on functional outcome was comparable between occlusion divisions (common odds ratio, 1.27; 95% CI, 1.06-1.53 for dominant M2; common odds ratio, 1.32; 95% CI, 0.93-1.87 for nondominant M2; and common odds ratio, 1.35; 95% CI, 1.24-1.46 for M1 occlusions).Conclusions-Outcomes and complication rates after EVT were similar in patients with M2 and M1 occlusions. Although based on observational data and a limited sample size, a similar association of reperfusion status with functional outcome for all subgroups provides no evidence that patients with either a dominant or a nondominant M2 occlusion should be routinely excluded from EVT.

AB - Background and Purpose-It is unclear whether endovascular treatment (EVT) is beneficial for patients with acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery. We aimed to compare functional outcomes, technical aspects, and complications of EVT between patients with acute ischemic stroke because of M2 and M1 occlusions in clinical practice. Furthermore, outcome and complications after EVT in dominant and nondominant caliber M2 division occlusions were studied.Methods-Data were obtained from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) which is an ongoing observational study in 16 Dutch centers performing EVT in the Netherlands. Functional outcome was measured with the modified Rankin Scale score at 90 days. Neurological recovery (delta National Institutes of Health Stroke Scale), successful reperfusion rates (extended Thrombolysis in Cerebral Infarction >= 2B), and safety outcomes were also investigated. Associations between occlusion location and outcome were analyzed with ordinal logistic regression models, with adjustment for other prognostic factors.Results-In total, 244 (24%) patients with an M2 and 759 (76%) patients with an M1 occlusion who underwent EVT were analyzed. Functional outcomes were not significantly different between patients with M2 versus M1 occlusions (adjusted common odds ratio, 1.24; 95% CI, 0.87-1.73). Occurrence of symptomatic intracerebral hemorrhage was also similar for M2 and M1 occlusions (6.6% versus 5.9%; P=0.84). Further analysis about dominance of an M2 branch was performed in 175 (72%) patients. Neurological recovery was comparable (mean delta National Institutes of Health Stroke Scale, -2 +/- 10 for dominant M2, -5 +/- 5 for nondominant M2, and -4 +/- 9 [P=0.24] for M1 occlusions). Furthermore, the effect of reperfusion status on functional outcome was comparable between occlusion divisions (common odds ratio, 1.27; 95% CI, 1.06-1.53 for dominant M2; common odds ratio, 1.32; 95% CI, 0.93-1.87 for nondominant M2; and common odds ratio, 1.35; 95% CI, 1.24-1.46 for M1 occlusions).Conclusions-Outcomes and complication rates after EVT were similar in patients with M2 and M1 occlusions. Although based on observational data and a limited sample size, a similar association of reperfusion status with functional outcome for all subgroups provides no evidence that patients with either a dominant or a nondominant M2 occlusion should be routinely excluded from EVT.

KW - middle cerebral artery

KW - reperfusion

KW - stroke

KW - thrombectomy

KW - treatment outcome

KW - MIDDLE CEREBRAL-ARTERY

KW - MECHANICAL THROMBECTOMY

KW - ANGIOGRAPHY

KW - OUTCOMES

KW - SCORE

KW - THERAPY

KW - M1

U2 - 10.1161/STROKEAHA.118.023117

DO - 10.1161/STROKEAHA.118.023117

M3 - Article

VL - 50

SP - 419

EP - 427

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 2

ER -

ID: 86388020