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Efficacy and safety of mechanical thrombectomy for M2 segment of middle cerebral artery: a systematic review and meta-analysis

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Abstract

Background and purpose

The efficacy and safety of mechanical thrombectomy (MT) for M2 segment occlusion of middle cerebral artery in patients with acute ischemic stroke (AIS) was investigated.

Methods

We searched PubMed and EMBASE from inception to 16 April 2019 for relevant studies, calculated the pool relative risks (RRs) of 3-month functional independence (modified Rankin scale score 0–2), death and symptomatic intracerebral hemorrhage (sICH) in MT for M2 segment occlusion in patients with AIS versus those of M1 segment or best medical care.

Results

Nine studies enrolling 2152 patients compared MT for patients with AIS of M2 segment occlusion and those of M1 segment occlusion. MT for M2 occlusion had a higher rate of 3-month functional independence compared to the patients with M1 occlusion. (RR 1.27, 95% CI 1.11–1.44, P < 0.001) and decreased death (RR 0.74; 95% CI 0.58–0.96, P = 0.022) with similar risk of sICH (RR 1.11; 95% CI 0.65–1.87, P = 0.707). Four studies enrolling 1016 patients compared MT and best medical care for patients with AIS of M2 occlusion. MT for M2 occlusion benefit more than best medical care on 3-month functional independence (RR 1.43, 95% CI 1.08–1.90, P = 0.011) and death (RR 0.46; 95% CI 0.22–0.96, P = 0.022) with similar risk of sICH (RR 1.65; 95% CI 0.66–4.13; P = 0.286).

Conclusion

MT for M2 segment benefit patients with AIS on 3-month functional independence compared with that of M1 segment or medical care, without increasing the risk of sICH.

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Authors and Affiliations

  1. Cerebrovascular Disease Center, Department of Neurology, People’s Hospital, China Medical University, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People’s Republic of China

    Jian Wang, Jiacheng Qian, Lu Fan & Yujie Wang

  2. Neurosurgery Department, The First Hospital of China Medical University, 155 Nanjing North Road, Heping District, Shenyang, 110001, People’s Republic of China

    Jian Wang

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  1. Jian Wang
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  2. Jiacheng Qian
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Contributions

JW and YJW contributed to the study conception and design. JW and JCQ did the systematic literature search, selected studies for inclusion and extracted data. JW and YJW did statistical analyses and made the figures. All the authors interpreted data. JW and YJW wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content and approved the final draft.

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Correspondence to Yujie Wang.

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All authors report no conflicts of interest.

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Wang, J., Qian, J., Fan, L. et al. Efficacy and safety of mechanical thrombectomy for M2 segment of middle cerebral artery: a systematic review and meta-analysis. J Neurol 268, 2346–2354 (2021). https://doi.org/10.1007/s00415-020-09710-w

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  • DOI: https://doi.org/10.1007/s00415-020-09710-w

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