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Title: Endovascular clot retrieval for M2 segment middle cerebral artery occlusion: a systematic review and meta-analysis.
Austin Authors: Findakly, Salam;Maingard, Julian;Phan, Kevin;Barras, Christen D;Jhamb, Ashu;Chandra, Ronil;Thijs, Vincent N ;Brooks, Mark;Asadi, Hamed 
Affiliation: School of Medicine, Deakin University, Geelong, Victoria, Australia
The University of Adelaide, Adelaide, South Australia, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Monash Health, Melbourne, Victoria, Australia
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Department of Imaging, Monash University, Melbourne, Victoria, Australia
The University of Melbourne, Melbourne, Victoria, Australia
Issue Date: May-2020
Publication information: Internal Medicine Journal 2020; 50(5): 530-541
Abstract: Endovascular clot retrieval (ECR) is the standard of care for acute ischaemic stroke due to large vessel occlusion. However, isolated occlusion of the M2 segment of the middle cerebral artery (MCA) was underrepresented in the landmark trials. Given the potential treatment benefit associated with M2 MCA occlusions, we aimed to evaluate the outcome of patients undergoing ECR for M2 occlusion. We conducted a systematic review and meta-analysis of the available literature that included patients with M2 MCA occlusions who underwent ECR. Successful reperfusion was defined as a treatment in cerebral ischaemia score of 2b-3. Good outcome was defined as a modified Rankin Scale score ≤ 2. We also analysed complications such as post-procedure symptomatic intracranial haemorrhage and mortality at 3 months. Fifteen studies including 1105 patients with isolated M2 occlusions were analysed. Successful reperfusion occurred in 75.4% (95% confidence interval (CI) 67.7-84.1%) of patients; good outcome was observed in 58.3% (95% CI 51.7-63.8% of patients. The rate of symptomatic intracranial haemorrhage was 5.1% (95% CI 4.2-8.3%), and 3-month mortality rate was 12.2% (95% CI 10.4-16.3%). The outcomes of ECR treatment of M2 occlusions are favourable, with good safety profile. Comparison to medical management from large registries or randomised controlled trials is warranted.
DOI: 10.1111/imj.14333
ORCID: 0000-0002-1177-2052
Journal: Internal Medicine Journal
PubMed URL: 31059208
Type: Journal Article
Subjects: M2
endovascular clot retrieval
ischaemic Stroke
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