Abstract 3308: Endovascular Treatment For Distal Middle Cerebral Artery Occlusions In Patients With Acute Ischemic Stroke: A Comparative Analysis.
Background: While, endovascular treatment is advocated for proximal arteries including M1 segment of middle cerebral artery (MCA), the role in distal middle cerebral artery (MCA) occlusions which are not always amenable to mechanical thrombectomy remains controversial.
Objective: To compare outcomes in endovascularly treated patients with distal MCA occlusions (M2 or beyond) with those treated with IV rt-PA or no treatment
Methods: Consecutive patients with acute ischemic stroke with distal MCA (M2 and beyond) occlusions diagnosed by either computed tomographic angiography (CTA) or catheter angiography over the last seven years were analyzed. We compared the rates of favorable outcome and mortality between the two groups. Favorable outcome was defined by discharge modified Rankin scale (mRS) score of 0-2. Multivariate logistical regression was performed to compare the outcomes after adjusting for potential confounders.
Results: 96 patients were included; mean age of 66.7±16.4, 44 (45.8%) were women. Of these 96 patients, 44 (45.8%) patients underwent endovascular treatment and 52 patients were treated with IV rt-PA or no treatment. There was no statistical difference in age, or cardiovascular risk factors between the two groups. Favorable outcome defined by mRS at discharge was similar 46% vs. 43%, p-value = 0.7. After adjusting for age, gender, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) score on admission, patients with endovascular treatment had a trend towards higher rates of favorable outcome; odds ratio (OR) 2.912 (confidence interval [CI] 0.807- 10.507) and lower rates of in-hospital mortality; OR 0.416 (CI 0.086 - 2.018).
Conclusion: Endovascular treatment may improve outcomes in patients with distal MCA occlusions and should be explored in future studies.
- © 2012 by American Heart Association, Inc.