In the Journals

Endovascular therapy effective for patients with stroke, second segment cerebral artery occlusion

Endovascular therapy is reasonable, safe and effective in treating patients with acute ischemic stroke with isolated second segment large vessel occlusions, according to a study published in JAMA Neurology.

Amrou Sarraj, MD, from the University of Texas at Houston Stroke Center, and colleagues evaluated endovascular therapy safety and effectiveness in patients with acute ischemic stroke with isolated second segment (M2) large vessel occlusions.

Amrou Sarraj

According to the researchers, randomized clinical trials have shown superiority of endovascular therapy over medical management in acute ischemic strokes with large vessel occlusion, but mainly for proximal occlusions, not M2 occlusions. They conducted a retrospective cohort study of patients with large vessel occlusions isolated to the M2 segments who presented within 8 hours of their last known normal clinical status.

The researchers analyzed data from 522 patients (51% women; mean age, 68 years) who were treated with endovascular therapy or medical management. The primary outcome was 90-day modified Rankin Scale score. The secondary outcome was symptomatic intracerebral hemorrhage.

The medical management cohort was older (median age, 73 years) and had higher rates of IV tissue plasminogen activator treatment (74% vs. 59.7%), according to the researchers.

The endovascular group was three times more likely than the medical management group to have a 90-day modified Rankin Scale score of 0 to 2 (OR = 3.1; 95% CI, 2.1-4.4), even after adjustment for age and other factors (OR = 3.2; 95% CI, 2-5.2), Sarraj and colleagues wrote.

The incidence of symptomatic intracerebral hemorrhage did not differ between the groups (endovascular group, 5.6%; medical management group, 2.1%; P = .1).

A successful primary outcome resulting from endovascular therapy was independently linked with age, NIH Stroke Scale score, Alberta Stroke Program Early Computed Tomographic Score, time from last known normal condition to reperfusion, and a successful reperfusion score of at least 2b (range, 0 [no perfusion] to 3 [full perfusion with filling of all distal branches]), according to the researchers.

In a related editorial, Jonathan M. Coutinho, MD, PhD, from the department of neurology, Academic Medical Centre, Amsterdam, wrote the study “adds important new data on the topic of mechanical thrombectomy for M2 occlusions. Although we must always be careful with the interpretation of results from nonrandomized studies, the data clearly suggest that it is at least reasonable to consider mechanical thrombectomy in these patients.” – by James Clark

Disclosure: Sarraj reports consulting for and receiving an unrestricted grant from Stryker Neurovascular. Please see the full study for a list of the other researchers’ relevant financial disclosures. Coutinho reports no relevant financial disclosures.

Endovascular therapy is reasonable, safe and effective in treating patients with acute ischemic stroke with isolated second segment large vessel occlusions, according to a study published in JAMA Neurology.

Amrou Sarraj, MD, from the University of Texas at Houston Stroke Center, and colleagues evaluated endovascular therapy safety and effectiveness in patients with acute ischemic stroke with isolated second segment (M2) large vessel occlusions.

Amrou Sarraj

According to the researchers, randomized clinical trials have shown superiority of endovascular therapy over medical management in acute ischemic strokes with large vessel occlusion, but mainly for proximal occlusions, not M2 occlusions. They conducted a retrospective cohort study of patients with large vessel occlusions isolated to the M2 segments who presented within 8 hours of their last known normal clinical status.

The researchers analyzed data from 522 patients (51% women; mean age, 68 years) who were treated with endovascular therapy or medical management. The primary outcome was 90-day modified Rankin Scale score. The secondary outcome was symptomatic intracerebral hemorrhage.

The medical management cohort was older (median age, 73 years) and had higher rates of IV tissue plasminogen activator treatment (74% vs. 59.7%), according to the researchers.

The endovascular group was three times more likely than the medical management group to have a 90-day modified Rankin Scale score of 0 to 2 (OR = 3.1; 95% CI, 2.1-4.4), even after adjustment for age and other factors (OR = 3.2; 95% CI, 2-5.2), Sarraj and colleagues wrote.

The incidence of symptomatic intracerebral hemorrhage did not differ between the groups (endovascular group, 5.6%; medical management group, 2.1%; P = .1).

A successful primary outcome resulting from endovascular therapy was independently linked with age, NIH Stroke Scale score, Alberta Stroke Program Early Computed Tomographic Score, time from last known normal condition to reperfusion, and a successful reperfusion score of at least 2b (range, 0 [no perfusion] to 3 [full perfusion with filling of all distal branches]), according to the researchers.

In a related editorial, Jonathan M. Coutinho, MD, PhD, from the department of neurology, Academic Medical Centre, Amsterdam, wrote the study “adds important new data on the topic of mechanical thrombectomy for M2 occlusions. Although we must always be careful with the interpretation of results from nonrandomized studies, the data clearly suggest that it is at least reasonable to consider mechanical thrombectomy in these patients.” – by James Clark

Disclosure: Sarraj reports consulting for and receiving an unrestricted grant from Stryker Neurovascular. Please see the full study for a list of the other researchers’ relevant financial disclosures. Coutinho reports no relevant financial disclosures.