Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study
Abstract Background Data on mechanical thrombectomy (MT) to treat M2 occlusions of the middle cerebral artery (MCA) are sparse. We report the outcome and safety of MT versus intravenous recombinant tissue plasminogen activator (IV rTPA) versus conventional medical treatment (CMT) of acute ischemic s...
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2025-01-01
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| Series: | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
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| Online Access: | https://doi.org/10.1186/s41983-025-00935-y |
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| author | Eman M. Khedr Ahmed Elbassiouny Mahmoud Nageeb Ahmed Aly Khalid O. Mohamed Nourelhoda A. Haridy |
| author_facet | Eman M. Khedr Ahmed Elbassiouny Mahmoud Nageeb Ahmed Aly Khalid O. Mohamed Nourelhoda A. Haridy |
| author_sort | Eman M. Khedr |
| collection | DOAJ |
| description | Abstract Background Data on mechanical thrombectomy (MT) to treat M2 occlusions of the middle cerebral artery (MCA) are sparse. We report the outcome and safety of MT versus intravenous recombinant tissue plasminogen activator (IV rTPA) versus conventional medical treatment (CMT) of acute ischemic stroke (AIS) due to occlusion of the M2 segment of the MCA. This prospective longitudinal intervention study compared the outcomes and safety of MT, rTPA, and CMT in M2 occlusion AIS patients. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and recanalization rate assessed outcomes. Results 74 AIS patients were recruited (23 MT, 23 rTPA, 28CMT). MT group had significantly higher admission NIHSS (p = 0.018) and mRS (p = 0.023) than rTPA. At 24 h, NIHSS improved more with MT and rTPA than CMT (p < 0.0001). At 3 months, mRS were better with MT and rTPA versus CMT (p < 0.0001). Successful recanalization occurred in 73.9% of the MT group. 69% of the MT group required stent retrieval plus aspiration thrombectomy, and 60.9% required ≥ 3 trials, but outcomes did not differ by technique or number of trials. A good outcome (mRS 0–2) at 3 months was achieved in 69.6% MT versus 65.2% rTPA versus 7.1% CMT (p < 0.0001). Symptomatic intracranial hemorrhage (sICH) rates were slightly, but insignificantly, higher with CMT. Mortality did not significantly differ between groups. Conclusions For M2 occlusions, MT and rTPA achieved better early and 3-month outcomes than CMT; however, MT was not superior to rTPA. MT of M2 is feasible and effective, with a lower hemorrhage rate than rTPA and CMT. Trial registration: This study was prospectively registered in the clinical trial with ClinicalTrials.gov ID (NCT05091320). The link: https://clinicaltrials.gov/study/NCT05091320 |
| format | Article |
| id | doaj-art-a6025f3c5e174fddb0527b48878b7282 |
| institution | Kabale University |
| issn | 1687-8329 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
| spelling | doaj-art-a6025f3c5e174fddb0527b48878b72822025-02-02T12:13:26ZengSpringerOpenThe Egyptian Journal of Neurology, Psychiatry and Neurosurgery1687-83292025-01-0161111210.1186/s41983-025-00935-yOutcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative studyEman M. Khedr0Ahmed Elbassiouny1Mahmoud Nageeb2Ahmed Aly3Khalid O. Mohamed4Nourelhoda A. Haridy5Department of Neurology and Psychiatry, Faculty of Medicine, Assiut UniversityNeurology Department, Faculty of Medicine, Ain Shams UniversityDepartment of Neurology and Psychiatry, Faculty of Medicine, Assiut UniversityDepartment of Neurosurgery, Faculty of Medicine, Aswan UniversityDepartment of Neurology and Psychiatry, Faculty of Medicine, Assiut UniversityDepartment of Neurology and Psychiatry, Faculty of Medicine, Assiut UniversityAbstract Background Data on mechanical thrombectomy (MT) to treat M2 occlusions of the middle cerebral artery (MCA) are sparse. We report the outcome and safety of MT versus intravenous recombinant tissue plasminogen activator (IV rTPA) versus conventional medical treatment (CMT) of acute ischemic stroke (AIS) due to occlusion of the M2 segment of the MCA. This prospective longitudinal intervention study compared the outcomes and safety of MT, rTPA, and CMT in M2 occlusion AIS patients. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and recanalization rate assessed outcomes. Results 74 AIS patients were recruited (23 MT, 23 rTPA, 28CMT). MT group had significantly higher admission NIHSS (p = 0.018) and mRS (p = 0.023) than rTPA. At 24 h, NIHSS improved more with MT and rTPA than CMT (p < 0.0001). At 3 months, mRS were better with MT and rTPA versus CMT (p < 0.0001). Successful recanalization occurred in 73.9% of the MT group. 69% of the MT group required stent retrieval plus aspiration thrombectomy, and 60.9% required ≥ 3 trials, but outcomes did not differ by technique or number of trials. A good outcome (mRS 0–2) at 3 months was achieved in 69.6% MT versus 65.2% rTPA versus 7.1% CMT (p < 0.0001). Symptomatic intracranial hemorrhage (sICH) rates were slightly, but insignificantly, higher with CMT. Mortality did not significantly differ between groups. Conclusions For M2 occlusions, MT and rTPA achieved better early and 3-month outcomes than CMT; however, MT was not superior to rTPA. MT of M2 is feasible and effective, with a lower hemorrhage rate than rTPA and CMT. Trial registration: This study was prospectively registered in the clinical trial with ClinicalTrials.gov ID (NCT05091320). The link: https://clinicaltrials.gov/study/NCT05091320https://doi.org/10.1186/s41983-025-00935-yMechanical thrombectomyrTPAM2 segmentCatheter retrieval |
| spellingShingle | Eman M. Khedr Ahmed Elbassiouny Mahmoud Nageeb Ahmed Aly Khalid O. Mohamed Nourelhoda A. Haridy Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study The Egyptian Journal of Neurology, Psychiatry and Neurosurgery Mechanical thrombectomy rTPA M2 segment Catheter retrieval |
| title | Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study |
| title_full | Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study |
| title_fullStr | Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study |
| title_full_unstemmed | Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study |
| title_short | Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study |
| title_sort | outcomes and safety of mechanical thrombectomy alteplase and conventional medical care in the treatment of acute m2 segment middle cerebral artery occlusion a comparative study |
| topic | Mechanical thrombectomy rTPA M2 segment Catheter retrieval |
| url | https://doi.org/10.1186/s41983-025-00935-y |
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