J Cerebrovasc Endovasc Neurosurg.  2021 Sep;23(3):193-200. 10.7461/jcen.2021.E2020.11.002.

Mechanical thrombectomy for acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: A literature review

• Cho YH
• Choi JH

• KMID: 2520878
• DOI: http://doi.org/10.7461/jcen.2021.E2020.11.002

Abstract

Thanks to new generation devices, mechanical thrombectomy (MT) has substantially evolved and become the standard treatment for patients with acute occlusion of the internal carotid artery or proximal middle cerebral artery (MCA) (M1 segment). However, the role and benefit of MT in patients with distal MCA (M2 segment) occlusion remain unclear. Therefore, there is a need for further studies. To evaluate the efficacy and safety of MT for M2 occlusion, this article reviews the natural course of M2 occlusion, the evidence regarding MT for M2 segment occlusion, clinical outcomes of MT for M2 occlusion, and treatment outcomes according to device type.

Keyword

Intervention; Middle cerebral artery; Stroke; Thrombectomy

Figure

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  Fig. 1. Illustrative case of mechanical thrombectomy for a patient with M2 occlusion. (A, B) DWI on admission shows acute infarction in the pre- and postcentral gyrus with perfusion defect in the left MCA territory. (C, D) Initial cerebral angiography reveals M2 segment occlusion of the left middle cerebral artery (anteroposterior and lateral views). (C) White arrow indicates the occlusion site. (D) The superior branch of MCA is not shown due to the occlusion. (E, F) Mechanical thrombectomy is performed using a stent-retriever. (E) White arrow indicates the occlusion site. (F) Recanalized blood flow and thrombus (white arrow) are identified after stent deploy. (G) The occlusion is recanalized after the first pass. (H, I) Final cerebral angiography (anteroposterior and lateral view) shows successful recanalization (mTICI 3). (J) Stent-retriever (Solitaire stent) and retrieved clot. (K, L) Magnetic resonance FLAIR images acquired at 1-postoperative week show no infarction extension compared with the initial diffusion-weighted image. DWI, Diffusion-weighted imaging; MCA, middle cerebral artery; mTICI, modified thrombolysis in cerebral ischemia, FLAIR, fluid-attenuated inversion recovery.

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