Early Neurological Deterioration in Patients with Minor Stroke due to Isolated M2 Occlusion Undergoing Medical Management: A Retrospective Multicenter Study
Francesca Colò1, Valerio Brunetti1, Andrea Maria Alexandre1, Iacopo Valente1, Giovanni Frisullo3, Alessandro Pedicelli1, Irene Scala1, Paolo Calabresi4, Aldobrando Broccolini2
1Policlinico Agostino Gemelli, 2Neurology, Policlinico Agostino Gemelli, 3Univ Catt S Cuore Polic Gemelli, 4Clinica Neurologica
Objective:

Here we report a retrospective multicenter analysis on consecutive patients with minor AIS due to isolated occlusion of the M2 segment that received best medical management (BMM) only or that initially received BMM but were then subjected to rescue mechanical thrombectomy (rMT) following an early worsening of symptoms. Our primary purpose was to define predictors of clinical outcome. The secondary aim was to identify predictors of early neurological deterioration (END).

Background:

END is frequent in patients with AIS due to involvement of the M2 segment and represents the most important predictor of long-term poor outcome in such patients. In case of END, rMT represents a feasible treatment option that can improve the clinical outcome. Hence, the search of baseline features for the identification of patients that are at risk for END is relevant.

Design/Methods:
Patients with M2 occlusion and a baseline NIHSS score≤5 that received either BMM only or rMT on END after BMM were extracted from the databases of 16 comprehensive stroke centers. Clinical outcome measures were a 90-day modified Rankin Scale (mRS) score of 0-1 or 0-2, and occurrence of END.
Results:

208 patients, admitted between 2016 and 2021, were collected. END was reported in 87 patients that were therefore all subjected to rMT. In a logistic regression model, END (OR 3.386, 95% CI 1.428-8.032), baseline NIHSS score (OR 1.362, 95% CI 1.004-1.848) and a pre-event mRS score=1 (OR 3.226, 95% CI 1.229- 8.465) were associated with unfavorable outcome. In patients with END, successful rMT was associated with favorable outcome (OR 4.549, 95% CI 1.098-18.851). Among baseline features, presence of atrial fibrillation was a predictor of END (OR 3.547, 95% CI 1.014-12.406).

Conclusions:
Patients with minor stroke due to M2 occlusion and atrial fibrillation should be closely monitored for possible worsening during BMM and, in this case, promptly considered for rMT.
10.1212/WNL.0000000000205158