Evaluation of the efficacy and safety of mechanical thrombectomy in patients presenting with acute ischemic stroke and occlusion in the middle cerebral artery m2 and/or m3 segments

Abstract Background Acute ischemic stroke is a clinical condition resulting from the occlusion of cerebral arteries, leading to neurological functional loss and necessitating emergency intervention. Mechanical thrombectomy (MT) has become the standard treatment due to its proven efficacy in large vessel occlusions. However, the effectiveness of thrombectomy in occlusions of the middle cerebral artery (MCA) M2 and M3 segments remains controversial. This study aimed to evaluate the efficacy, clinical outcomes, and complications of MT in patients with MCA M2/M3 segment occlusions. Method In this retrospective study, the data of patients who presented to Harran University Hospital between January 2021 and December 2023 with a diagnosis of acute ischemic stroke, had occlusions in the MCA M2/M3 segments, and underwent MT were analyzed. Demographic data, neurological status before and after stroke, thrombectomy method, revascularization success, and rates of functional recovery were assessed. Revascularization success was evaluated using the Thrombolysis in Cerebral Infarction (TICI) grade, and functional independence was assessed using the modified Rankin Scale (mRS). Complications, procedural failures, and mortality rates were recorded. Results Of the 98 patients included in the study, 46.9% were male, and the mean age was 69.7 ± 12.2 years. The rate of technical success (TICI grades 2b–3) was 81.6% (n = 80). Clinical success (mRS: 0–2) was achieved in 71.4% (n = 70) of the patients. The mean age in the group with clinical success (mRS score: 0–2) was significantly lower than in the other group (67.8 ± 12.4 vs. 67.8 ± 12.4, p = 0.016). The rate of procedural complications in the clinical success group was significantly lower compared to the other group (14.2% vs. 2.8%, p = 0.033), while the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was higher (9.2 ± 0.8 vs. 8.5 ± 0.9, p < 0.001), and the National Institutes of Health Stroke Scale score was lower (13.7 ± 3.7 vs. 16.1 ± 5.2, p = 0.072). In the group with high technical success (TICI grades 2b–3), compared to those without (TICI grades 0–2a), the ASPECTS was higher (9.2 ± 0.8 vs. 8.3 ± 0.9, p = 0.001), and the mortality rate was lower (12.5% vs. 44.4%, p = 0.004). Conclusion This study suggests that MT may be an effective treatment option in selected patients with MCA M2/M3 segment occlusions. However, due to the high complication rates and the need to determine optimal treatment strategies, there is a need for large-scale, prospective studies. The safety and clinical outcomes of thrombectomy applied to the distal segments of the MCA should be further supported by more comprehensive research.