Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience
Background Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. Objective To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. Methods We studied patients prospectively included in t...
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| Veröffentlicht in: | Journal of neurointerventional surgery 2015-04, Vol.7 (4), p.234-237 |
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| creator | Flores, Alan Tomasello, Alejandro Cardona, Pere de Miquel, M Angeles Gomis, Meritxell Garcia Bermejo, Pablo Obach, Victor Urra, Xabi Martí-Fàbregas, Joan Cánovas, David Roquer, Jaume Abilleira, Sònia Ribó, Marc |
| description | Background Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. Objective To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. Methods We studied patients prospectively included in the SONIIA registry (years 2011–2012)—a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b–3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score |
| doi_str_mv | 10.1136/neurintsurg-2014-011100 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1664196971</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1664196971</sourcerecordid><originalsourceid>FETCH-LOGICAL-b520t-729f5cabedba622a7b7990867bc34e11fbc4a687edcb80053c8fa8ccfe5175503</originalsourceid><addsrcrecordid>eNqN0UtPHSEYBmBiatTa_oWWpBs30wIzXMZdY-wl0bjRNQHmm5aTGTjlcmL_vZhjjenKFSQ83xvgRegjJZ8p7cWXADX5UHJNvzpG6NARSikhB-iESj52alDizfNeqmP0NucNIUJyyY_QMRu4bKY_Qf4yTHFnsquLSbgkMGWFUPAcE75mODq31OxjyNgHXH4DhmRwnHEuTSUPO0j5HBs8QXbJb4vfAV7rUrxr55Aw3G-hseDgHTqczZLh_dN6iu6-Xd5e_Oiubr7_vPh61VnOSOkkG2fujIXJGsGYkVaOI1FCWtcPQOls3WCEkjA5qwjhvVOzUc7NwNtzOelP0dk-d5vinwq56NVnB8tiAsSaNRVioKMYJW300390E2sK7XaaSiUUYUM_NCX3yqWYc4JZb5NfTfqrKdGPbegXbejHNvS-jTb54Sm_2hWm57l_398A2wO7bl6d-gAbhpvt</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1786802434</pqid></control><display><type>article</type><title>Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Flores, Alan ; Tomasello, Alejandro ; Cardona, Pere ; de Miquel, M Angeles ; Gomis, Meritxell ; Garcia Bermejo, Pablo ; Obach, Victor ; Urra, Xabi ; Martí-Fàbregas, Joan ; Cánovas, David ; Roquer, Jaume ; Abilleira, Sònia ; Ribó, Marc</creator><creatorcontrib>Flores, Alan ; Tomasello, Alejandro ; Cardona, Pere ; de Miquel, M Angeles ; Gomis, Meritxell ; Garcia Bermejo, Pablo ; Obach, Victor ; Urra, Xabi ; Martí-Fàbregas, Joan ; Cánovas, David ; Roquer, Jaume ; Abilleira, Sònia ; Ribó, Marc ; Catalan Stroke Code and Reperfusion Consortium Cat-SCR</creatorcontrib><description>Background Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. Objective To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. Methods We studied patients prospectively included in the SONIIA registry (years 2011–2012)—a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b–3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24–36 h; and good outcome as modified Rankin score (mRS) 0–2 at 3 months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume. Results Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289±195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0–2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01). Conclusions Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.</description><identifier>ISSN: 1759-8478</identifier><identifier>EISSN: 1759-8486</identifier><identifier>DOI: 10.1136/neurintsurg-2014-011100</identifier><identifier>PMID: 24578483</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Aged ; Aged, 80 and over ; Endovascular Procedures - instrumentation ; Endovascular Procedures - methods ; Female ; Humans ; Infarction, Middle Cerebral Artery - diagnosis ; Infarction, Middle Cerebral Artery - surgery ; Male ; Middle Aged ; Prospective Studies ; Stents ; Treatment Outcome</subject><ispartof>Journal of neurointerventional surgery, 2015-04, Vol.7 (4), p.234-237</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b520t-729f5cabedba622a7b7990867bc34e11fbc4a687edcb80053c8fa8ccfe5175503</citedby><cites>FETCH-LOGICAL-b520t-729f5cabedba622a7b7990867bc34e11fbc4a687edcb80053c8fa8ccfe5175503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jnis.bmj.com/content/7/4/234.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jnis.bmj.com/content/7/4/234.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24578483$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Flores, Alan</creatorcontrib><creatorcontrib>Tomasello, Alejandro</creatorcontrib><creatorcontrib>Cardona, Pere</creatorcontrib><creatorcontrib>de Miquel, M Angeles</creatorcontrib><creatorcontrib>Gomis, Meritxell</creatorcontrib><creatorcontrib>Garcia Bermejo, Pablo</creatorcontrib><creatorcontrib>Obach, Victor</creatorcontrib><creatorcontrib>Urra, Xabi</creatorcontrib><creatorcontrib>Martí-Fàbregas, Joan</creatorcontrib><creatorcontrib>Cánovas, David</creatorcontrib><creatorcontrib>Roquer, Jaume</creatorcontrib><creatorcontrib>Abilleira, Sònia</creatorcontrib><creatorcontrib>Ribó, Marc</creatorcontrib><creatorcontrib>Catalan Stroke Code and Reperfusion Consortium Cat-SCR</creatorcontrib><title>Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience</title><title>Journal of neurointerventional surgery</title><addtitle>J Neurointerv Surg</addtitle><description>Background Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. Objective To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. Methods We studied patients prospectively included in the SONIIA registry (years 2011–2012)—a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b–3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24–36 h; and good outcome as modified Rankin score (mRS) 0–2 at 3 months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume. Results Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289±195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0–2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01). Conclusions Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Infarction, Middle Cerebral Artery - diagnosis</subject><subject>Infarction, Middle Cerebral Artery - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Stents</subject><subject>Treatment Outcome</subject><issn>1759-8478</issn><issn>1759-8486</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqN0UtPHSEYBmBiatTa_oWWpBs30wIzXMZdY-wl0bjRNQHmm5aTGTjlcmL_vZhjjenKFSQ83xvgRegjJZ8p7cWXADX5UHJNvzpG6NARSikhB-iESj52alDizfNeqmP0NucNIUJyyY_QMRu4bKY_Qf4yTHFnsquLSbgkMGWFUPAcE75mODq31OxjyNgHXH4DhmRwnHEuTSUPO0j5HBs8QXbJb4vfAV7rUrxr55Aw3G-hseDgHTqczZLh_dN6iu6-Xd5e_Oiubr7_vPh61VnOSOkkG2fujIXJGsGYkVaOI1FCWtcPQOls3WCEkjA5qwjhvVOzUc7NwNtzOelP0dk-d5vinwq56NVnB8tiAsSaNRVioKMYJW300390E2sK7XaaSiUUYUM_NCX3yqWYc4JZb5NfTfqrKdGPbegXbejHNvS-jTb54Sm_2hWm57l_398A2wO7bl6d-gAbhpvt</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Flores, Alan</creator><creator>Tomasello, Alejandro</creator><creator>Cardona, Pere</creator><creator>de Miquel, M Angeles</creator><creator>Gomis, Meritxell</creator><creator>Garcia Bermejo, Pablo</creator><creator>Obach, Victor</creator><creator>Urra, Xabi</creator><creator>Martí-Fàbregas, Joan</creator><creator>Cánovas, David</creator><creator>Roquer, Jaume</creator><creator>Abilleira, Sònia</creator><creator>Ribó, Marc</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience</title><author>Flores, Alan ; Tomasello, Alejandro ; Cardona, Pere ; de Miquel, M Angeles ; Gomis, Meritxell ; Garcia Bermejo, Pablo ; Obach, Victor ; Urra, Xabi ; Martí-Fàbregas, Joan ; Cánovas, David ; Roquer, Jaume ; Abilleira, Sònia ; Ribó, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b520t-729f5cabedba622a7b7990867bc34e11fbc4a687edcb80053c8fa8ccfe5175503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - diagnosis</topic><topic>Infarction, Middle Cerebral Artery - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Stents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Flores, Alan</creatorcontrib><creatorcontrib>Tomasello, Alejandro</creatorcontrib><creatorcontrib>Cardona, Pere</creatorcontrib><creatorcontrib>de Miquel, M Angeles</creatorcontrib><creatorcontrib>Gomis, Meritxell</creatorcontrib><creatorcontrib>Garcia Bermejo, Pablo</creatorcontrib><creatorcontrib>Obach, Victor</creatorcontrib><creatorcontrib>Urra, Xabi</creatorcontrib><creatorcontrib>Martí-Fàbregas, Joan</creatorcontrib><creatorcontrib>Cánovas, David</creatorcontrib><creatorcontrib>Roquer, Jaume</creatorcontrib><creatorcontrib>Abilleira, Sònia</creatorcontrib><creatorcontrib>Ribó, Marc</creatorcontrib><creatorcontrib>Catalan Stroke Code and Reperfusion Consortium Cat-SCR</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurointerventional surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Flores, Alan</au><au>Tomasello, Alejandro</au><au>Cardona, Pere</au><au>de Miquel, M Angeles</au><au>Gomis, Meritxell</au><au>Garcia Bermejo, Pablo</au><au>Obach, Victor</au><au>Urra, Xabi</au><au>Martí-Fàbregas, Joan</au><au>Cánovas, David</au><au>Roquer, Jaume</au><au>Abilleira, Sònia</au><au>Ribó, Marc</au><aucorp>Catalan Stroke Code and Reperfusion Consortium Cat-SCR</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience</atitle><jtitle>Journal of neurointerventional surgery</jtitle><addtitle>J Neurointerv Surg</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>7</volume><issue>4</issue><spage>234</spage><epage>237</epage><pages>234-237</pages><issn>1759-8478</issn><eissn>1759-8486</eissn><abstract>Background Patients with M2 middle cerebral artery (MCA) occlusions are not always considered for endovascular treatment. Objective To study outcomes in patients with M2 occlusion treated with endovascular procedures in the era of stentrievers. Methods We studied patients prospectively included in the SONIIA registry (years 2011–2012)—a mandatory, externally audited registry that monitors the quality of reperfusion therapies in Catalonia in routine practice. Good recanalization was defined as postprocedure Thrombolysis in Cerebral Infarction (TICI) score 2b–3; dramatic recovery as drop in National Institutes of Health Stroke Scale (NIHSS) score >10 points or NIHSS score <2 at 24–36 h; and good outcome as modified Rankin score (mRS) 0–2 at 3 months. A 24 h CT scan determined symptomatic intracranial hemorrhage (SICH) and infarct volume. Results Of 571 patients who received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram, preprocedure NIHSS 16 (IQR 6). Mean time from symptom onset to groin puncture was 289±195 min. According to interventionalist preferences 86.2% (n=56) were treated with stentrievers (n=7 in combination with intra-arterial tissue plasminogen activator (tPA), 4.6% (n=3) received intra-arterial tPA only, and 9.2% (n=6) diagnostic angiography only. Good recanalization (78.5%) was associated with dramatic improvement (48% vs 14.8%; p=0.02), smaller infarct volumes (8 vs 82 cc; p=0.01) and better outcome (mRS 0–2: 66.3% vs 30%; p=0.03). SICH (9%) was not associated with treatment modality or device used. After adjusting for age and preprocedure NIHSS, good recanalization emerged as an independent predictor of dramatic improvement (OR=5.9 (95% CI 1.2 to 29.2), p=0.03). Independent predictors of good outcome at 3 months were age ( OR=1.067 (95% CI 1.005 to 1132), p=0.03) and baseline NIHSS ( OR=1.162 (95% CI 1.041 to 1.297), p<0.01). Conclusions Endovascular treatment of M2 MCA occlusion with stentrievers seems safe. Induced recanalization may double the chances of achieving a favorable outcome, especially for patients with moderate or severe deficit.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>24578483</pmid><doi>10.1136/neurintsurg-2014-011100</doi><tpages>4</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Endovascular Procedures - instrumentation Endovascular Procedures - methods Female Humans Infarction, Middle Cerebral Artery - diagnosis Infarction, Middle Cerebral Artery - surgery Male Middle Aged Prospective Studies Stents Treatment Outcome |
| title | Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience |
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