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Abstract Details

Endovascular therapy for M2 Occlusions: Does the Benefit Outweigh the Risk?
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
035

To determine if EVT improves outcomes for patients with M2 occlusions in spite of higher rates of symptomatic intracranial hemorrhage (sICH).

EVT is an invaluable treatment for patients with large vessel occlusions (LVOs). However, there are several challenges to consider when using EVT to treat M2 occlusions: theoretically, more distal occlusions are associated with a smaller core and therefore less benefit may be seen following EVT, thinner vessel walls may carry higher risk of EVT complications, and the most effective EVT technique has not yet been determined for M2 occlusions.
A retrospective chart review of 309 patients presenting with an LVO during a 3-year period revealed 77 patients (24.9%) with an M2 occlusion. Primary outcome was modified Rankin Score (mRS) at discharge and 90-day follow-up (Good: mRS≤2 ). Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS), recanalization (Good: TICI≥2B), sICH, and mortality. Chi-squared test was used to compare outcomes between EVT, tPA, or no intervention.
Presenting NIH was statistically the same between all three groups. 5/77 (6.5%) received EVT; 24/77 (31.2%) received tPA; 49/77 (63.6%) received no intervention. Of the patients receiving EVT, 4/5 achieved TICI ≥ 2B. There was no significant difference in good discharge mRS (EVT: 40%, tPA: 37.5%, no intervention: 52.1%, p=0.4311) or 90-day mRS (EVT: 50%, tPA: 60%, no intervention: 57.5%, p=0.7429). There was significantly more sICH in the EVT group (EVT: 60%, tPA: 8.3%, no intervention: 2.1%, p=0.00002). There was no significant difference in mortality (EVT: 40%, tPA: 15%, no intervention: 27.5%, p=0.4346).
There was significantly more sICH in the EVT group, which is similar to other studies in the literature. However, there was no significant difference in clinical outcome between the three groups. Larger, prospective trials are needed to determine which patients with M2 occlusions will have improved functional outcomes following EVT.
Authors/Disclosures
Jessica Frey, MD (West Virginia University)
PRESENTER 		The institution of Dr. Frey has received research support from Tourette Association of America.
Phong T. Vu, MD (West Virginia University) Dr. Vu has nothing to disclose.
No disclosure on file
No disclosure on file
Amelia K. Adcock, MD (WVU School of Medicine, Dept. of Neurology) The institution of an immediate family member of Dr. Adcock has received research support from NIH.