Abstract

Background: The efficacy of endovascular thrombectomy (EVT) in M2 occlusions is uncertain. Methods: In a pooled patient level analysis of the prospective multicenter cohort study of imaging selection (SELECT) and the INternational Stroke Perfusion Imaging REgistry (INSPIRE) EVT outcomes were compared to medical management (MM) in M2 occlusions. Further, we assessed for potential treatment benefit in patients with higher stroke severity (NIHSS). The primary outcome was excellent outcome (mRS 0-1). Results: 387 patients with isolated M2 occlusion (EVT 112, MM 275) met the inclusion criteria. Baseline NIHSS median (IQR) (EVT: 13 (9-19), MM: 10 (6-15), p<0.001) and infarct volume rCBF<30% (EVT 11 (4-24) vs MM: 8 (3-16), P=0.11). EVT was associated with a trend towards higher rates of excellent outcomes (48% vs 44%, aOR:2.80, 95% CI=0.95-8.25, p=0.061) with a shift towards better mRS outcomes (adj cOR: 2.57, 95% CI=1.11-5.94, p=0.028), and a reduction of neurological worsening (27% vs 47%, p<0.001) and numerically lower rates of sICH (4.5% vs 6.5%, p=0.43), and mortality (4.5% vs 9.5%, p=0.10). Assessing outcomes in NIHSS strata; there was no significant difference in excellent outcomes rates in patients with NIHSS ≤10 (EVT 62% vs MM 57%, aOR=2.18, 95% CI=0.30-15.73, p=0.44). In contrast, patients with NIHSS>10 had a trend towards higher excellent outcome rates outcomes with EVT (43%) vs MM (27%), aOR=3.11, 95% CI=0.81-11.95, p=0.098) as shown in figure 1. Conclusion: EVT may result in better rates of excellent outcomes in isolated M2 occlusions, especially those with more severe strokes who are more likely to have worse outcomes without emergent reperfusion.

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