Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

Huanwen Chen; Marco Colasurdo; Hidetoshi Matsukawa; Conor Cunningham; Ilko Maier; Pascal Jabbour; Joon-Tae Kim; Stacey Quintero Wolfe; Ansaar Rai; Robert M Starke; Marios-Nikos Psychogios; Amir Shaban; Nitin Goyal; Shinichi Yoshimura; Hugo Cuellar; Brian Howard; Ali Alawieh; Ali Alaraj; Mohamad Ezzeldin; Daniele G Romano; Omar Tanweer; Justin Mascitelli; Isabel Fragata; Adam Polifka; Fazeel Siddiqui; Joshua Osbun; Roberto Crosa; Ramesh Grandhi; Charles Matouk; Min S Park; Michael R Levitt; Waleed Brinjikji; Mark Moss; Ergun Daglioglu; Richard Williamson Jr; Pedro Navia; Shakeel Chowdhry; David J Altschul; Alejandro M Spiotta; Peter Kan

doi:10.1177/15910199251343283

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Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

Journal article

Peer reviewed

Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients

Huanwen Chen, Marco Colasurdo, Hidetoshi Matsukawa, Conor Cunningham, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, …

Interventional neuroradiology

06/18/2025

DOI: 10.1177/15910199251343283

PMCID: PMC12176791

PMID: 40530425

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Abstract

BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included. Primary outcome was futile EVT reperfusion (defined as 90-day modified Rankin scale of 5 or 6). Other outcomes of interest include acceptable outcomes (modified Rankin scale of 3 or less) and intracranial hemorrhage (ICH), and all-cause 90-day mortality. Outcomes for M1 patients were compared to M2 patients with multivariable logistic regression models accounting for potential confounders.Results173 patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT were identified. After multivariable adjustments, M2 patients had significantly higher odds of futile reperfusion (OR 5.48 [95%CI 1.91 to 15.7], p = 0.002), lower odds of acceptable outcomes (OR 0.33 [95%CI 0.12 to 0.89], p = 0.028), and higher odds of all-cause mortality (OR 4.90 [95%CI 1.65 to 14.5], p = 0.004). These findings suggest that EVT's efficacy for low-ASPECTS stroke patients may be diminished for patients with M2 occlusions. M2 occlusion was not significantly associated with ICH.ConclusionsAmong low-ASEPCTS stroke patients who underwent successful EVT, those with M2 occlusions had significantly higher odds of poor outcome compared to those with M1 occlusions.

Stroke

medium

ASPECTS

thrombectomy

Details

Title: Subtitle: Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients
Creators: Huanwen Chen - MedStar Georgetown University Hospital
Marco Colasurdo - Oregon Health and Science University Hospital
Hidetoshi Matsukawa - Medical University of South Carolina
Conor Cunningham - Medical University of South Carolina
Ilko Maier - Universitätsmedizin Göttingen
Pascal Jabbour - Thomas Jefferson University
Joon-Tae Kim - Chonnam National University Hospital
Stacey Quintero Wolfe - Atrium Health Wake Forest Baptist
Ansaar Rai - West Virginia University
Robert M Starke - University of Miami Health System
Marios-Nikos Psychogios - Universitätsspital Basel, Basel, Switzerland
Amir Shaban - University of Iowa
Nitin Goyal - Semmes Murphey Foundation
Shinichi Yoshimura - Hyogo Medical University
Hugo Cuellar - Louisiana State University Health Sciences Center Shreveport
Brian Howard - Emory University
Ali Alawieh - Emory University
Ali Alaraj - University of Illinois Chicago
Mohamad Ezzeldin - Lone Star College Kingwood
Daniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona
Omar Tanweer - Baylor College of Medicine
Justin Mascitelli - The University of Texas Health Science Center at San Antonio
Isabel Fragata - Universidade Nova de Lisboa
Adam Polifka - University of Florida
Fazeel Siddiqui - University of Michigan
Joshua Osbun - Washington University in St. Louis
Roberto Crosa - Administracion de los Servicios de Salud del Estado
Ramesh Grandhi - University of Utah
Charles Matouk - Yale University
Min S Park - University of Virginia
Michael R Levitt - University of Washington
Waleed Brinjikji - Mayo Clinic
Mark Moss - Washington Regional Medical Center
Ergun Daglioglu - Ankara Bilkent City Hospital
Richard Williamson Jr - Allegheny Health Network
Pedro Navia - Hospital Universitario La Paz
Shakeel Chowdhry - NorthShore University HealthSystem
David J Altschul - Montefiore Medical Center
Alejandro M Spiotta - Medical University of South Carolina
Peter Kan - The University of Texas Medical Branch at Galveston
Resource Type: Journal article
Publication Details: Interventional neuroradiology
DOI: 10.1177/15910199251343283
PMID: 40530425
PMCID: PMC12176791
NLM abbreviation: Interv Neuroradiol
ISSN: 2385-2011
eISSN: 2385-2011
Publisher: SAGE PUBLICATIONS INC; THOUSAND OAKS
Grant note: StrykerMedtronicRapidAIMicroventionBrain Aneurysm FoundationPenumbra
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:This work was supported by the Stryker, Medtronic, RapidAI,Microvention, Brain Aneurysm Foundation, Penumbra.
Language: English
Electronic publication date: 06/18/2025
Academic Unit: Neurology
Record Identifier: 9984832182702771

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