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Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The purpose of this study was to evaluate differences in endovascular treatment (EVT) outcomes in M1 segment middle cerebral artery occlusion (MCAO) patients with different pathologic subtypes.

Methods

Patients with MCAO who received EVT from July 2014 to December 2020 were categorized into three groups: embolism without internal carotid artery steno-occlusion (MCAO-E), in situ atherosclerotic thrombosis (MCAO-AS) and embolism from tandem ICA steno-occlusion (MCAO-T). Baseline characteristics, EVT-related factors and clinical outcomes were compared between groups. Multivariable regression analyses were performed to evaluate the relationship between aetiologic classification and outcomes at 90 days after stroke.

Results

Among eligible patients (n = 220), MCAO-E (n = 129, 58.6%) was the most common aetiology, followed by MCAO-AS (n = 47, 21.4%) and MCAO-T (n = 44, 20.0%). Patients with MCAO-E were significantly older but had a lower rate of dyslipidaemia and smoking history than those with MCAO-AS. Although patients with MCAO-AS and MCAO-T more often required rescue balloon angioplasty and stenting (p < 0.001), no significant difference in the rate of final recanalization was found. Patients in the MCAO-AS group obtained better functional outcomes (90-day modified Rankin Scale score, 0–2) (p = 0.002) and lower mortality than in the MCAO-E group (p = 0.009). On multivariable logistic regression, we failed to find that stroke subtype was an independent predictor of functional outcomes and mortality.

Conclusions

Patients with acute MCA M1 occlusion stroke due to different pathogeneses had comparable successful recanalization rates and functional independence at 90 days. The optimal management for MCAO patients with different aetiologies requires further research.

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Availability of data and materials

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Statistical code is available upon reasonable request.

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Funding

This work was supported by the Anhui University Provincial Natural Science Research Project (No. KJ2021A0843) and the Scientific Research Project for middle-aged and young people of Wannan Medical College (No. WK2020F24).

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    Authors and Affiliations

    1. Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, China

      Xiangjun Xu, Ke Yang, Junfeng Xu, Qian Yang, Yapeng Guo, Youqing Xu, Hao Wang, Liang Ge, Zhiming Zhou & Xianjun Huang

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    Contributions

    XX, XH, and ZZ planned and conceived the study. WH and GL collected the data. QY and KY analyzed the image; YG and XY interpreted the data. XX, KY, WW, and JX wrote and critically revised the manuscript. All the authors have read and approved the final manuscript.

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    Correspondence to Zhiming Zhou or Xianjun Huang.

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    We declare that we have no conflict of interest.

    Ethics approval

    Subjects (or their parents or guardians) have given their written informed consent for being treated. The paper is exempt from ethical committee approval, since endovascular thrombectomy is considered the standard of care for treating acute ischemic stroke, and there has been no disclosure of the patients’ information in this paper.

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    Xiangjun Xu, Ke Yang and Junfeng Xu contributed equally to this work.

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    Xu, X., Yang, K., Xu, J. et al. Endovascular treatment in patients with middle cerebral artery occlusion of different aetiologies. Neuroradiology 65, 609–618 (2023). https://doi.org/10.1007/s00234-022-03078-6

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