Does the Stent Retriever Placement in the Division of Middle Cerebral Artery Affect the Recanalization Success in M1 Occlusions?

Abstract

The location of arterial occlusions can be predictive in the prognosis and endovascular treatment of acute stroke patients. We aimed to determine if the location of the stent retriever being on the superior or inferior division of the middle cerebral artery has an effect on the success and clinical outcomes of recanalization in middle cerebral artery M1 occlusion. Data were generated for the period from May 2015 to January 2019. Divisions of middle cerebral artery were assigned to the 2 groups as superior and inferior divisions according to the anatomical classification. The dominant trunk of the artery was assessed on the last angiogram image. We eventually included 81/90 patients (mean age: 62 ± 13.5; 63% [51/81] female; mean National Institutes of Health Stroke Scale rating: 16.3 ± 3.6) treated with thrombectomy. The branches of the middle cerebral artery were as follows: 40 (49.4%) co-dominant, 22 (27.2%) inferior, and 19 (23.5%) superior division dominant. The stent retriever was placed in the dominant trunk in 22/41(53.7%) cases at first pass. When stent retriever was placed in the dominant middle cerebral artery trunk, the rate of successful recanalization was very high with the first pass of thrombectomy (P < .001). Stent retriever placement within the superior or inferior middle cerebral artery trunk does not have an effect on the success rate of recanalization; however, its placement in the dominant trunk can increase the chance of complete recanalization to be early.