Unexpected language recovery after proximal left middle cerebral artery versus left M1 arterial segment thrombectomy
Benjamin Hopper1, Rayhan Shams2, Manas Kinra3, Tanzid Shams4
1School of Osteopathic Medicine, Lincoln Memorial University, 2Biomedical Magnet Track, Wheaton High School, 3Department of Neuroscience, University of California Riverside, 4Neurology, Ballad Health
Objective:
Left MCA strokes are the most common type of strokes. Prognostic questions regarding patient’s language recovery are come up very frequently in clinical settings. The impact of exact location of left MCA thrombus on post-thrombectomy language outcome has not been well characterized.
Background:
The relationship between arterial segment location and post-thrombectomy language recovery remains underexplored. We analyzed language outcomes based on the location of thrombus on the proximal left MCA versus left arterial M1 segment.
Design/Methods:
A retrospective analysis of 160 patients undergoing thrombectomy for proximal left MCA vs. distal M1 occlusions was performed. Baseline demographics, stroke severity, and language function were collected. Language outcomes were measured with NIHSS language sub-score (Item 9) pre- and 24 hours post-thrombectomy. Patients with baseline aphasia (Item-9 >0) and ≥1 point improvement at 24 hours were analyzed. Multivariable logistic regression was used to compare groups, adjusting for age, sex, baseline Item-9, thrombolytic use, and reperfusion success.
Results:
160 patients with baseline aphasia were included (53.12% female, mean age [71.09 ± 13.78]). In this cohort, left MCA main trunk vs. distal M1 was associated with lower odds of ≥1 point language improvement at 24 h (adjusted OR 0.48, 95% CI 0.24–0.95, p= 0.0362). Female sex showed higher odds of improvement (OR 2.05, 1.01–4.26, p= 0.0469). Greater baseline Item-9 severity trended toward lower odds (OR 0.67, 0.42–1.05). Thrombolytic use was not associated with improvement (OR 1.05, 0.48–2.40). Model discrimination: AUC 0.65 (95% CI 0.56–0.74).
Conclusions:
After thrombectomy, patients with distal left M1 thrombus demonstrated significantly greater early (24-hour) language improvement compared to patients with proximal left MCA occlusions following thrombectomy independent of age, baseline language severity, thrombolytic use, and reperfusion success. These findings support thrombus location as a practical predictor for early language recovery and may assist bedside prognostication after thrombectomy.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.