Different endovascular procedures for stroke with isolated M2-segment MCA occlusion: a real-world experience


Acute ischemic stroke with isolated occlusion of the M2-segment middle cerebral artery (MCA) has not been a focus of trials on mechanical thrombectomy (MT) thus far. We aimed to assess outcomes in stroke patients treated with different endovascular procedures versus direct MT alone for isolated M2-MCA occlusion. We conducted a cohort study on data from 506 stroke patients with isolated M2-MCA occlusion who were enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort. We calculated odds ratio (OR) with confidence interval (CI) of different endovascular procedures (vs direct MT alone) for outcomes after adjustment for age, enrollment period, pre-stroke mRS score, NIHSS score, ASPECT score, onset-to-groin time, and procedure time. Endovascular procedures were direct MT alone (n = 156), intravenous thrombolysis (IVT) plus MT (n = 266), MT plus intra-arterial thrombolysis (IAT) (n = 43), and IAT alone (n = 41). MT plus IAT was associated with higher rates of TICI 2b/3 (OR 3.281, 95% CI 1.006–10.704), 3-month mRS 0–1 (OR 4.153, 95% CI 1.267–13.612), and 3-month mRS 0–2 (OR 4.497, 95% CI 1.485–13.617). IAT alone was associated with lower rates of TICI 3 (OR 0.348, 95% CI 0.139–0.874) and TICI 2b/3 (OR 0.369, 95% CI 0.144–0.948). IVT plus MT was associated with higher rate of asymptomatic ICH (OR 2.526, 95% CI 1.145–5.571). No significant difference was found between different endovascular procedures and direct MT alone as regards symptomatic ICH and 3-month death. In stroke patients with isolated M2-MCA occlusion, MT plus IAT was associated with better outcomes as compared with direct MT alone.

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We thank all patients enrolled in the study.


“The project ‘‘Registro Nazionale Trattamento Ictus Acuto’’ (RFPS-2006–1-336562) was funded by grants from the Italian Ministry of Health within the framework of 2006 Finalized Research Programmes (D.Lgs.n.502/1992).

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Correspondence to Manuel Cappellari.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Need for ethical approval or patient consent for participation in the IRETAS varied among participating hospitals. Ethical approval and informed consent were obtained when required.

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Cappellari, M., Saia, V., Pracucci, G. et al. Different endovascular procedures for stroke with isolated M2-segment MCA occlusion: a real-world experience. J Thromb Thrombolysis (2021). https://doi.org/10.1007/s11239-021-02378-7

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  • Thrombectomy
  • Stroke
  • Isolated M2-MCA occlusion