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m2_segment_of_the_middle_cerebral_artery

M2 segment of the middle cerebral artery

M2: from bi (tri) furcation to origin of cortical branches (circular sulcus of insula); also known as insular segment.

The vascular supply of the insula is mainly provided by the M2 segment of the middle cerebral artery, which constitutes a substantial obstacle to any open or stereotactic procedure aiming at the insular region.

The long insular arteries originate from the insular portion of the middle cerebral artery and supply the corona radiata and the descending motor tract.

Middle cerebral artery M2 segment occlusion

Miura et al., compared the efficacy of endovascular therapy (EVT) with that of medical treatment in 'real-world 'patients with M2 occlusion.

This was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0-2 at 90 days) using forest plots of treatment effects.

Overall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9-19] vs 10 [5-16]) and earlier onset to hospital door time (110 [50-258] vs 150 [60-343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.

In patients with M2 occlusion, this registry suggests that EVT is effective and safe 1).

Pathology

1)
Miura M, Yoshimura S, Sakai N, Yamagami H, Uchida K, Nagao Y, Morimoto T. Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2. J Neurointerv Surg. 2019 Mar 9. pii: neurintsurg-2018-014627. doi: 10.1136/neurintsurg-2018-014627. [Epub ahead of print] PubMed PMID: 30852524.
m2_segment_of_the_middle_cerebral_artery.txt · Last modified: 2019/12/03 13:56 by administrador