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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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m3 segments Eyüp Kaya, Sebahattin Arslan, Mehmet Tahtabasi, Ahmed Adam Osman, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7273475/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Acute ischemic stroke mechanical thrombectomy middle cerebral artery endovascular treatment revascularization Figures Figure 1 Figure 2 Figure 3 Background Acute ischemic stroke (AIS) is among the leading causes of morbidity and mortality worldwide and constitutes a significant public health concern [ 1 ]. Randomized controlled trials concerning AIS due to large vessel occlusions (LVOs) (internal cerebral artery [ICA] and middle cerebral artery [MCA] M1) have demonstrated the efficacy of mechanical thrombectomy (MT) and its superiority over medical therapy (recombinant tissue plasminogen activator and thrombolytic therapy), resulting in the inclusion of this technique in clinical guidelines [ 2 , 3 ]. These studies and guidelines have also standardized procedural aspects such as indications for MT in LVO, patient selection, treatment window, and imaging modalities [ 2 , 3 ]. However, uncertainties persist regarding the management of occlusions in the more distal segments of the MCA, namely M2 and M3, and the application of MT at these levels [ 4 ]. Although distal occlusions (DOs) cause infarction in a smaller parenchymal area compared to LVOs, they still carry the potential to cause significant neurological and functional deficits, which underscores the importance of patient management. The natural course of DOs also varies. Some of these occlusions may regress spontaneously, and in patients with good collateral circulation, they may cause tolerable, limited damage. This raises the issue of distinguishing patients who require treatment from those who do not. The scarcity of studies on this subject, in contrast to patients with LVOs, contributes to uncertainties in patient selection and indications for treatment. Further uncertainties include determining the most appropriate endovascular treatment technique, the treatment window, and the diagnostic and follow-up imaging methods to be used [ 2 , 4 ]. This retrospective study aimed to present the treatment outcomes of patients diagnosed with AIS at Sanliurfa Harran University Hospital between January 2021 and December 2023 who had occlusions in the M2 and/or M3 segments and underwent MT and to evaluate the efficacy and safety of MT in patients with DOs, particularly in occlusions of the MCA M2 and M3 segments. MATERIALS AND METHODS Study Design and Ethical Approval This retrospective study was conducted at the Department of Radiology of Harran University Faculty of Medicine. Ethical approval for the study was obtained from the Clinical Research Ethics Committee of the university on June 6, 2024. Patient Population and Selection Criteria The medical records of patients diagnosed with AIS and treated with MT at Harran University Faculty of Medicine Hospital between January 2021 and December 2023 were retrospectively reviewed. Data from a total of 496 patients who underwent emergency intervention for ischemic stroke were evaluated. MT was performed in 460 patients, excluding 36 patients who either did not require MT or in whom the procedure could not be performed due to technical reasons. Of these, 62 patients had ICA tandem occlusion or distal ICA occlusion, 201 had MCA M1 segment occlusion, 65 had vertebrobasilar system occlusion (vertebral arteries, basilar artery, and posterior cerebral artery [PCA] P1 segment), and 34 had distal vessel occlusions other than MCA M2/M3 (ACA A1-A2, PCA P2). These patients were excluded from the study. As a result, 98 patients who underwent MT due to MCA M2 or M3 segment occlusion were included in the study. The following conditions were required for patients undergoing MT: presentation within the first six to eight hours from symptom onset, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 6 or higher, National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher, and the presence of appropriate indications for MT (5,8). Data Collection The following data of patients included in the study were retrospectively collected from hospital archives: demographic characteristics (age and sex), comorbidities, time elapsed since symptom onset, side of occlusion (right/left), level of occlusion (M2/M3), method used in MT (isolated aspiration, stent retriever, and aspiration combined therapy), occurrence of complications during the procedure, status of collateral circulation (good, moderate, or poor compared to the symmetrical side), hemorrhage status in control computed tomography (CT) at 24 hours (present/absent), modified Rankin Scale (mRS) score at three months, and Thrombolysis in Cerebral Infarction (TICI) grade. MT Procedure Procedures were performed under the guidance of monoplanar digital subtraction angiography (DSA) (Azurion 5 M20 Image Guided Therapy System Monoplane Ceiling/Floor Mounted, Philips Healthcare). Sedation was administered to most patients, whereas those who could not tolerate sedation were transitioned to general anesthesia. During the procedure, cardiac rhythm, pulse oximetry, and blood pressure were continuously monitored. Following completion of preoperative preparation and local anesthesia administration, vascular access was obtained predominantly through the right femoral artery (or left femoral artery in cases of occlusion) and, in patients with unsuitable anatomy, via the right brachial or right radial artery. Based on the access site, a 6–8-French, 11-cm introducer was placed. Heparin was not routinely administered; however, in cases of catheter system thrombosis, 50–80 IU/kg intravenous (IV) heparin was used. Through the introducer, a 6-French long sheath catheter (NeuronMax-Penumbra, Fubuki-Asahi, Benchmark BMX96-Penumbra, AXS Infinity LS Plus-Stryker) was advanced to an appropriate level in the distal ICA. Isolated Aspiration In cases where isolated aspiration was performed, an aspiration catheter (SOFIA 6F MicroVention-Terumo, AXS-Stryker, Neuron ACE64 max system-Penumbra, Neurocath-Taha Medical) was advanced over a microguidewire and microcatheter to the proximal portion of the clot through the long sheath. Manual aspiration was performed for 2 minutes using a 50-cc syringe. In cases where sufficient recanalization was achieved, the procedure was terminated. In cases of inadequate recanalization, the procedure was repeated and/or transitioned to the stent retriever technique. Combined Technique (Stent Retriever and Aspiration) In patients for whom the isolated aspiration method failed or was unsuitable, access to the thrombus level was achieved via the aspiration catheter using a microguidewire (Traxcess Microvention-Terumo, Hybrid Balt-Montmorency, Synchro-Stryker) and microcatheter (Rebar-Medtronic, Headway 21 MicroVention-Terumo). After the microguidewire reached the clot, it was removed, and a stent retriever was deployed through the microcatheter. Depending on the occlusion site and vascular anatomy at that level, in some patients, the stent was partially deployed distal to the clot to allow advancement of the aspiration catheter. In anatomically suitable patients, the stent was fully deployed and thrombectomy was performed. In patients with challenging anatomy, to minimize distal embolization and increase thrombectomy success, the aspiration catheter was held at the proximal level of MCA M2 to halt flow, and thrombectomy was carried out with the stent retriever under weak aspiration. In cases where recanalization was achieved on control angiograms, the procedure was concluded, while in those where recanalization could not be achieved, the intervention was repeated up to a maximum of five attempts. Evaluation of Outcomes To assess the efficacy of MT, post-procedural TICI grades were recorded. TICI grades and occlusion levels were independently assessed by two interventional radiologists. A TICI grade of 0–2a was considered inadequate revascularization, while a score of 2b–3 was considered adequate revascularization. To assess clinical response, the mRS score at three months after treatment was recorded. An mRS score of 0–2 was defined as successful treatment, and a score of 3–6 was considered unsuccessful. Statistical Analysis Statistical analysis of the data obtained from the study was performed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation and median (minimum–maximum) values, while categorical variables were presented as numbers and percentages. The normality of the data distribution was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. For normally distributed variables, Student’s t-test (for comparisons between two groups) and one-way analysis of variance (for comparisons among more than two groups) were used. For non-normally distributed continuous variables, the Mann-Whitney U test and Kruskal-Wallis H test were applied. To compare the distribution of categorical variables between groups, the Pearson chi-square test and, when necessary, Fisher’s exact test were used. Appropriate parametric and non-parametric tests were applied for the analysis of continuous variables such as the TICI grade, NIHSS score, and ASPECTS. Pearson and Spearman correlation coefficients were calculated to assess relationships between variables such as clinical success (90-day mRS score) and TICI grade. Suitable statistical tests were used to examine associations with mortality and complications. All hypothesis tests were conducted as two-tailed, and a p-value of < 0.05 was considered statistically significant. RESULTS Of the total 98 patients included in the study, 46 (46.9%) were male and 52 were female, with a mean age of 69.7 ± 12.2 years for the entire cohort. The characteristics of all patients are presented in Table 1 . The most frequently observed site of occlusion was the left MCA M2 segment (n = 62, 61.2%). The mean ASPECT and NIHSS scores at presentation were 9.1 ± 0.9 (range: 7–10) and 14.4 ± 4.2 (range: 8–28), respectively. On pre-procedural CT angiography, moderate collateralization (n = 52, 53.1%) was most commonly observed. The combined method involving both stent retriever and aspiration was the most frequently employed MT technique (n = 88, 89.8%). On control brain CT scans performed at 24 hours after the procedure, intracranial hemorrhage was detected in six patients as a complication. Table 1 Demographic, clinical, and procedural characteristics of the patients Variables n = 98 Sex Male 46 (46.9) Female 52 (53.1) Age (years) 69.7 ± 12.2 Localization Right MCA M2 28 (28.6) Left MCA M2 62 (61.2) Right MCA M3 4 (4.1) Left MCA M3 6 (6.1) ASPECTS 9.1 ± 0.9 NIHSS score 14.4 ± 4.2 Collateral status Poor (type 2) 36 (36.7) Moderate (type 3) 52 (53.1) Good (type 4) 10 (10.2) Endovascular treatment method Combined 88 (89.8) Isolated aspiration 10 (10.2) Complication during procedure 6 (6.1) Hemorrhage on control CT 24 (24.5) MCA: middle cerebral artery, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, CT: computed tomography Considering all patients, at 90 days after treatment, 70 cases (71.4%) achieved an mRS score between 0 and 2, indicating sufficient clinical success. The mean age of these 70 patients was 67.8 ± 12.4 years (p = 0.016). The overall mean time to presentation was 4.1 ± 1.5 hours, and this average was slightly lower (3.9 ± 1.5 hours) in patients with lower mRS scores (p = 0.288). The mean ASPECTS for all included patients was 9.1 ± 0.9, being recorded as 9.2 ± 0.8 in the mRS 0–2 group and 8.5 ± 0.9 in the mRS 3–6 group (p = 0.001). Among patients with an overall mean NIHSS score of 14.4 ± 4.2, the score was calculated to be 13.7 ± 3.7 in the mRS 0–2 group and 16.1 ± 5.2 in the mRS 3–6 group (p = 0.072). Of the 70 patients with an mRS score of 0–2, sufficient revascularization was achieved in 64 (91.4%, p < 0.001). The combined technique, the most commonly preferred method (n = 88, 89.8%), was used in 60 of the patients with an mRS score of 0–2 (85.7%, p = 0.028). Intracranial hemorrhage was observed in six patients (6.1%, p = 0.033) who showed extravasation during the procedure and underwent immediate post-procedural control brain CT. Table 2 presents the relationship between clinical treatment outcomes and associated variables. Table 2 Relationship of clinical treatment success and outcomes with variables mRS score (0–2) n = 70 mRS score (3–6) n = 28 All patients n = 98 p Sex (male) 36 (51.4) 10 (35.7) 46 (46.9) 0.118 Age, years 67.8 ± 12.4 74.3 ± 10.5 69.7 ± 12.2 0.016 Time to presentation, hours 3.9 ± 1.5 4.3 ± 1.4 4.1 ± 1.5 0.288 ASPECTS 9.2 ± 0.8 8.5 ± 0.9 9.1 ± 0.9 0.001 NIHSS score 13.7 ± 3.7 16.1 ± 5.2 14.4 ± 4.2 0.072 TICI grade (2b–3) 64 (91.4) 16 (57.1) 80 (81.6) < 0.001 Method (combined) 60 (85.7) 28 (100) 88 (89.8) 0.028 Complication during procedure 2 (2.8) 4 (14.2) 6 (6.1) 0.033 Collateral status Poor 20 (28.6) 16 (57.1) 36 (36.7) 0.032 Moderate 42 (60.0) 10 (35.7) 52 (53.1) Good 8 (11.4) 2 (7.1) 10 (10.2) Hemorrhage on 24-hour control CT 16 (22.9) 8 (28.6) 24 (24.5) 0.363 Comorbidity 64 (91.4) 24 (85.7) 88 (89.8) 0.306 mRS: modified Rankin Scale, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, TICI: Thrombolysis in Cerebral Infarction, CT: computed tomography In this study, technical procedural success was evaluated according to the TICI grade, with scores of 2b–3 being considered successful. Among cases where TICI grades 2b–3 recanalization was achieved (n = 80, 81.6%), the mean time to presentation was 3.9 ± 1.5 hours (p = 0.074), and the mean ASPECTS was 9.2 ± 0.8 (p = 0.001). Mortality occurred within the first three months in 18 out of 98 patients. Ten of these patients had a TICI grade of 2b–3 (12.5%, p = 0.004). Other variables and findings based on the TICI recanalization grade are presented in Table 3 . Table 3 Relationship of technical success with variables TICI grade (2b–3) n = 80 TICI grade (0–2a) n = 18 p Sex (male), n(%) 38 (47.5) 8 (44.4) 0.512 Age, years 69.1 ± 12.7 72.2 ± 9.4 0.419 Time to presentation, hours 3.9 ± 1.5 4.5 ± 1.3 0.074 ASPECTS 9.2 ± 0.8 8.3 ± 0.9 0.001 NIHSS score 14.2 ± 3.7 15.5 ± 6.1 0.580 Method (combined), n(%) 70 (87.5) 18 (100) 0.118 Complication during procedure 4 (5.0) 2 (11.1) 0.303 Collateral status Poor 28 (35.0) 8 (44.4) 0.109 Moderate 42 (52.5) 10 (55.6) Good 10 (12.5) 0 (0) Hemorrhage on control CT 18 (22.5) 6 (33.3) 0.248 Mortality 10 (12.5) 8 (44.4) 0.004 TICI: Thrombolysis in Cerebral Infarction, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, CT: computed tomography Figures 1 , 2 , and 3 present the imaging of patients who underwent MT for MCA M2 or M3 occlusion. DISCUSSION The most significant finding of this study, which retrospectively evaluated the outcomes, efficacy, and safety of MT in 98 patients with AIS presenting with occlusion in the MCA M2 and/or M3 segments, is the achievement of a high technical success rate (81.6%) indicating adequate revascularization (TICI grades 2b–3), and a high functional independence rate (71.4%), indicating favorable clinical outcomes (mRS at three months ≤ 2). These results are generally consistent with the existing literature, including several randomized clinical trials since 2015 focusing on LVOs that included a small number of patients with DOs (MR CLEAN, REVASCAT, ESCAPE, EXTEND-IA, and SWIFT PRIME studies), which have demonstrated the efficacy and safety of MT [ 5 – 9 ]. However, the limited number of patients with occlusion in distal segments such as MCA M2 and M3 in these studies raises uncertainty about the generalizability of their findings to these specific segments. This limitation underscores the importance of our study, as it focuses specifically on this patient subgroup. Differences in patient selection criteria, MT techniques employed, and procedural timing in various studies may explain the variation in the adequate revascularization rate (TICI grades 2b–3) of 81.6% in our study. This rate is higher than in some major LVO-focused trials that guide clinical practice (MR RESCUE, IMS III, REVASCAT, ESCAPE, and MR CLEAN) and lower than in others (EXTEND IA, SWIFT, NASA, and TREVO 2) [ 5 – 13 ] (Table 4 ). Table 4 Comparison of revascularization and functional independence rates between our study and major studies focusing on large vessel occlusions and evaluating the efficacy of mechanical thrombectomy in acute ischemic stroke Study Revascularization (%) Functional independence (mRS score ≤ 2) (%) MR RESCUE 67 21 IMS III 70 40.8 REVASCAT 65 44 ESCAPE 72.4 53 MR CLEAN 59 32.6 EXTEND IA 94 71 SWIFT 88 60 NASA 87.5 42 TREVO 2 85 40 Current study 81.6 71.4 mRS: modified Rankin Scale More specifically, our revascularization rate was better than those reported by Flores et al. (78.5%) and Sarraj et al. (78%) in studies assessing the efficacy of MT in occlusions of DOs or the MCA M2 segment; however, it was lower than the rates reported by Coutinho et al. (85%), Dorn et al. (93%), and Bhogal et al. (90.5%) [ 14 – 18 ] (Table 5 ). These varying technical success rates highlight the ongoing debate in the literature regarding the optimal treatment approach for DOs. Table 5 Comparison of revascularization and functional independence rates between our study and major studies focusing on distal occlusions (MCA M2) and evaluating the efficacy of mechanical thrombectomy in acute ischemic stroke Study Number of patients Revascularization (%) Functional independence (mRS score ≤ 2) (%) Flores et al. 65 78.5 60 Coutinho et al. 50 85 60 Sarraj et al. 288 78 62.8 Dorn et al. 15 93 60 Bhogal et al. 106 90.5 54.6 Current study 98 81.6 71.4 mRS: modified Rankin Scale Except for the EXTEND IA study (71%), our functional independence rate (71.4%) was higher than that of all other LVO-focused studies. This result can be attributed to the fact that our study specifically targeted DOs (MCA M2 and M3) and to the better prognosis generally associated with distal branch occlusions compared to LVOs (Table 4 ). Compared with other studies evaluating MT in MCA M2 segment occlusions, our study yielded more favorable results in terms of functional independence. This may stem from differences in patient selection criteria, MT techniques applied, or other clinical management factors (Table 5 ). Prognostic Factors In this study, the mean ASPECTS of the functionally independent group (mRS ≤ 2) was found to be significantly higher than that of the dependent group. This finding supports existing literature indicating that a higher ASPECTS (indicating less affected parenchyma and smaller established infarct zones) is associated with better clinical outcomes. Furthermore, the fact that 91.4% of patients with adequate revascularization belonged to the functionally independent group demonstrates that successful recanalization is a critical determinant of clinical improvement. This finding supports current guidelines recommending MT as a treatment option in M2 occlusions. Complications and Mortality In our study, complications occurred in 6.1% of procedures, and intracranial hemorrhage was detected in 24.5% of cases. These rates are similar to or lower than those reported in other studies [ 14 , 18 ], and it can be explained by our center’s experience and careful patient selection. The mortality rate in our study was 18.4%, which is similar to some reports in the literature while differing from others [ 14 ]. These differences may be attributable to variations in patient populations, comorbidities, and differences in management during follow-up. The lower mortality rate among patients with adequate revascularization further emphasizes the importance of successful recanalization for quality of life and survival. Strengths and Limitations of the Study One of the notable strengths of this study lies in its specific focus on occlusions in the MCA M2 and M3 segments, a patient group that has often been underrepresented in previous large-scale trials. Another strength is its reflection of real-world clinical practice, as the data were derived from routine patient care rather than a controlled trial environment. The study also benefits from a sufficiently large sample size. However, several limitations should be acknowledged, including the retrospective and single-center design. In addition, as all patients were diagnosed and treated at a dedicated stroke center without receiving IV thrombolysis, the study could not evaluate the comparative efficacy of IV thrombolysis in patients with DOs. CONCLUSION This retrospective study provides important insight into the efficacy and safety of MT in patients with AIS presenting with MCA M2 and M3 segment occlusions. Our findings offer significant implications for clinical practice, suggesting that MT may be a safe and effective treatment method for selected cases in this patient population. However, further prospective studies are necessary to generalize these findings to broader populations. Abbreviations MCA Middle cerebral artery MT Mechanical thrombectomy TICI Thrombolysis in Cerebral Infarction mRS modified Rankin Scale ASPECT Alberta Stroke Program Early Computed Tomography Score LVO Large vessel occlusion CTA Computed tomography angiography PCA posterior cerebral artery NIHSS National Institutes of Health Stroke Scale DSA Digital subtraction angiography ICA Internal cerebral artery Declarations Acknowledgements Not applicable. Authors’ contributions EK, SA, MT, VK, AG and EC designed the study. MT and EK contributed equally to this work. EK analyzed and interpreted the data with AG, AAO, VK, EC, MT and EU. EK and MT wrote the manuscript. AAO, EU provided scientific support and valuable advice. All authors proofread the manuscript and revised it critically. All authors read and approved the final manuscript. Funding The authors declare that they received no funding for this study. Availability of data and materials All data that are relevant for the study are included in this published article. Further datasets analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical approval for this study was obtained from the Ethics Committee of Harran University. Because the study was retrospective in nature and conducted using patient records, the Ethics Committee waived the requirement for written informed consent to participate, in accordance with national regulations. Competing interests The authors declare that they have no competing interests. References Katan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38:208–11. https://doi.org/10.1055/s-0038-1649503. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49. https://doi.org/10.1161/STR.0000000000000158. Jadhav AP, Desai SM, Jovin TG. Indications for Mechanical Thrombectomy for Acute Ischemic Stroke. Neurology. 2021;97 20_Supplement_2. https://doi.org/10.1212/WNL.0000000000012801. Psychogios M, Brehm A, Ribo M, Rizzo F, Strbian D, Räty S, et al. Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels. N Engl J Med. 2025;392:1374–84. https://doi.org/10.1056/NEJMoa2408954. Fransen PS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343. https://doi.org/10.1186/1745-6215-15-343. Molina CA, Chamorro A, Rovira À, de Miquel A, Serena J, Roman LS, et al. REVASCAT: A Randomized Trial of Revascularization with Solitaire FR® Device vs. Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight-Hours of Symptom Onset. Int J Stroke. 2015;10:619–26. https://doi.org/10.1111/ijs.12157. Issa Y, Kempeneers MA, Bruno MJ, Fockens P, Poley J-W, Ahmed Ali U, et al. Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis. JAMA. 2020;323:237. https://doi.org/10.1001/jama.2019.20967. Campbell BC V., Mitchell PJ, Yan B, Parsons MW, Christensen S, Churilov L, et al. A Multicenter, Randomized, Controlled Study to Investigate Extending the Time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial Therapy (EXTEND-IA). Int J Stroke. 2014;9:126–32. https://doi.org/10.1111/ijs.12206. Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, et al. Solitaire TM with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) Trial: Protocol for a Randomized, Controlled, Multicenter Study Comparing the Solitaire Revascularization Device with IV tPA with IV t. Int J Stroke. 2015;10:439–48. https://doi.org/10.1111/ijs.12459. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380:1231–40. https://doi.org/10.1016/S0140-6736(12)61299-9. Kidwell CS, Jahan R, Alger JR, Schaewe TJ, Guzy J, Starkman S, et al. Design and Rationale of the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) Trial. Int J Stroke. 2014;9:110–6. https://doi.org/10.1111/j.1747-4949.2012.00894.x. Broderick JP, Berkhemer OA, Palesch YY, Dippel DWJ, Foster LD, Roos YBWEM, et al. Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke. Stroke. 2015;46:3416–22. https://doi.org/10.1161/STROKEAHA.115.011397. Zaidat OO, Castonguay AC, Gupta R, Sun C-HJ, Martin C, Holloway WE, et al. North American Solitaire Stent Retriever Acute Stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg. 2018;10 Suppl 1:i45–9. https://doi.org/10.1136/neurintsurg-2013-010895.rep. Bhogal P, Bücke P, Aguilar Pérez M, Ganslandt O, Bäzner H, Henkes H. Mechanical Thrombectomy for M2 Occlusions: A Single-Centre Experience. Interv Neurol. 2017;6:117–25. https://doi.org/10.1159/000458161. Sarraj A, Parsons M, Bivard A, Hassan AE, Abraham MG, Wu T, et al. Endovascular Thrombectomy Versus Medical Management in Isolated M2 Occlusions: Pooled Patient‐Level Analysis from the EXTEND‐IA Trials, INSPIRE, and SELECT Studies. Ann Neurol. 2022;91:629–39. https://doi.org/10.1002/ana.26331. Flores A, Tomasello A, Cardona P, de Miquel MA, Gomis M, Garcia Bermejo P, et al. Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience. J Neurointerv Surg. 2015;7:234–7. https://doi.org/10.1136/neurintsurg-2014-011100. Coutinho JM, Liebeskind DS, Slater L-A, Nogueira RG, Baxter BW, Levy EI, et al. Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies. Am J Neuroradiol. 2016;37:667–72. https://doi.org/10.3174/ajnr.A4591. Sakai Y, Yoshikawa G, Koizumi S, Ishikawa O, Saito A, Sato K. Complete Recanalization in Mechanical Thrombectomy Is Associated with Favorable Functional Outcome for M2 Occlusions. J Neuroendovascular Ther. 2023;17:oa.2022-0057. https://doi.org/10.5797/jnet.oa.2022-0057. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7273475","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515706521,"identity":"5561c133-0e22-48b0-b6fe-3461c4bb2f88","order_by":0,"name":"Eyüp Kaya","email":"","orcid":"","institution":"Harran University","correspondingAuthor":false,"prefix":"","firstName":"Eyüp","middleName":"","lastName":"Kaya","suffix":""},{"id":515706522,"identity":"1133d014-c7c8-4ac7-98df-16de9e468bd3","order_by":1,"name":"Sebahattin Arslan","email":"","orcid":"","institution":"Harran 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09:26:11","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100039,"visible":true,"origin":"","legend":"","description":"","filename":"c0aa334fc2af4a659567e178a2ad43491structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/e171e984b4683695e3a0c838.xml"},{"id":91834487,"identity":"3a411dde-b8d2-4d1c-8723-c386f7ebf66a","added_by":"auto","created_at":"2025-09-22 09:26:14","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110511,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/a7bb4dcdc8b42a50fe567f2a.html"},{"id":91834496,"identity":"e2fc0c19-5e41-4c03-836c-50d609550677","added_by":"auto","created_at":"2025-09-22 09:26:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":387282,"visible":true,"origin":"","legend":"\u003cp\u003eImages of a 71-year-old male patient with a known history of diabetes mellitus presenting to the emergency department with acute stroke symptoms at the fourth hour of symptom onset. Non-contrast cranial CT excluded intracranial hemorrhage. Subsequent diffusion-weighted MRI (\u003cstrong\u003eA:\u003c/strong\u003e diffusion B1000 image; \u003cstrong\u003eB:\u003c/strong\u003eADC image) revealed cortical-subcortical diffusion restriction adjacent to the left Sylvian fissure. The patient was referred to our interventional radiology unit with a preliminary diagnosis of acute ischemic infarction. DSA confirmed occlusion in the superior division of the left MCA M2 segment (\u003cstrong\u003eC, D\u003c/strong\u003e). Mechanical thrombectomy was performed using a combined technique (aspiration and stent retriever), and the clot was successfully removed. Post-procedural DSA images (\u003cstrong\u003eE, F\u003c/strong\u003e) demonstrated complete recanalization with a TICI grade of 3. The procedure and post-procedural course were uneventful, and the patient had an mRS score of 1 at 90-day follow-up (MCA: middle cerebral artery, CT: computed tomography, ADC: apparent diffusion coefficient, DSA: digital subtraction angiography, TICI: Thrombolysis in Cerebral Infarction, mRS: modified Rankin Scale).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/68dd4d87f5fcf49366810f7f.png"},{"id":91834457,"identity":"aea895f2-6555-468c-9da9-15fec4f8e48f","added_by":"auto","created_at":"2025-09-22 09:26:13","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":873616,"visible":true,"origin":"","legend":"\u003cp\u003eImages of a 58-year-old male patient with known coronary artery disease, hypertension, and chronic heart failure presenting to our interventional radiology clinic within four hours of symptom onset with a preliminary diagnosis of acute ischemic infarction. \u003cstrong\u003e(A)\u003c/strong\u003e DSA showed an occlusion (blue arrow) in the superior division of the right MCA M2 segment. \u003cstrong\u003e(B)\u003c/strong\u003e The occlusion site was traversed using a microguidewire and microcatheter, and luminal patency was confirmed via contrast injection. \u003cstrong\u003e(C) \u003c/strong\u003eA stent retriever (blue arrow) was deployed through the microcatheter into the occluded lumen, followed by a combined mechanical thrombectomy using aspiration via a 50-cc syringe and the stent retriever technique. \u003cstrong\u003e(D)\u003c/strong\u003e Post-procedural imaging demonstrated recanalization of the occluded segment (blue arrow) with a TICI grade of 3. No complications occurred during or after the procedure, and the patient’s 90-day mRS score was recorded as 1 (MCA: middle cerebral artery, DSA: digital subtraction angiography, TICI: Thrombolysis in Cerebral Infarction, mRS: modified Rankin Scale).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/a5440cccb5b7d44fc0c69ab1.jpeg"},{"id":91834442,"identity":"7165a5e8-aa6c-4a7f-89be-1d73ac5902a2","added_by":"auto","created_at":"2025-09-22 09:26:12","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":835971,"visible":true,"origin":"","legend":"\u003cp\u003eImages of a 74-year-old male patient presenting to our clinic within three hours of symptom onset. \u003cstrong\u003e(A) \u003c/strong\u003eDiagnostic cerebral angiography revealed an occlusion (blue arrow) at the level of the superior division of the right MCA M3 segment. \u003cstrong\u003e(B)\u003c/strong\u003e After confirming luminal patency, a combined approach was used, deploying a stent retriever followed by mechanical thrombectomy under negative aspiration pressure. \u003cstrong\u003e(C)\u003c/strong\u003e Post-procedural imaging demonstrated successful recanalization of the occluded segment with a TICI grade of 3, and the procedure was completed without complications. \u003cstrong\u003e(D)\u003c/strong\u003e Follow-up non-contrast brain CT performed 24 hours later showed no evidence of significant hemorrhage or hypodense areas suggestive of established infarction (MCA: middle cerebral artery, DSA: digital subtraction angiography, TICI: Thrombolysis in Cerebral Infarction, CT: computed tomography).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/e28dd92d21bf2fdf40baff4b.jpeg"},{"id":106397769,"identity":"eb92250f-a17a-4cf6-8fc6-ba517b6e353c","added_by":"auto","created_at":"2026-04-08 08:14:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3384327,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7273475/v1/c7d6d1f6-0a64-4d88-a597-1bf5d42ab9bf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute ischemic stroke (AIS) is among the leading causes of morbidity and mortality worldwide and constitutes a significant public health concern [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Randomized controlled trials concerning AIS due to large vessel occlusions (LVOs) (internal cerebral artery [ICA] and middle cerebral artery [MCA] M1) have demonstrated the efficacy of mechanical thrombectomy (MT) and its superiority over medical therapy (recombinant tissue plasminogen activator and thrombolytic therapy), resulting in the inclusion of this technique in clinical guidelines [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These studies and guidelines have also standardized procedural aspects such as indications for MT in LVO, patient selection, treatment window, and imaging modalities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, uncertainties persist regarding the management of occlusions in the more distal segments of the MCA, namely M2 and M3, and the application of MT at these levels [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough distal occlusions (DOs) cause infarction in a smaller parenchymal area compared to LVOs, they still carry the potential to cause significant neurological and functional deficits, which underscores the importance of patient management. The natural course of DOs also varies. Some of these occlusions may regress spontaneously, and in patients with good collateral circulation, they may cause tolerable, limited damage. This raises the issue of distinguishing patients who require treatment from those who do not. The scarcity of studies on this subject, in contrast to patients with LVOs, contributes to uncertainties in patient selection and indications for treatment. Further uncertainties include determining the most appropriate endovascular treatment technique, the treatment window, and the diagnostic and follow-up imaging methods to be used [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis retrospective study aimed to present the treatment outcomes of patients diagnosed with AIS at Sanliurfa Harran University Hospital between January 2021 and December 2023 who had occlusions in the M2 and/or M3 segments and underwent MT and to evaluate the efficacy and safety of MT in patients with DOs, particularly in occlusions of the MCA M2 and M3 segments.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Ethical Approval\u003c/h2\u003e\u003cp\u003eThis retrospective study was conducted at the Department of Radiology of Harran University Faculty of Medicine. Ethical approval for the study was obtained from the Clinical Research Ethics Committee of the university on June 6, 2024.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatient Population and Selection Criteria\u003c/h3\u003e\n\u003cp\u003eThe medical records of patients diagnosed with AIS and treated with MT at Harran University Faculty of Medicine Hospital between January 2021 and December 2023 were retrospectively reviewed. Data from a total of 496 patients who underwent emergency intervention for ischemic stroke were evaluated. MT was performed in 460 patients, excluding 36 patients who either did not require MT or in whom the procedure could not be performed due to technical reasons. Of these, 62 patients had ICA tandem occlusion or distal ICA occlusion, 201 had MCA M1 segment occlusion, 65 had vertebrobasilar system occlusion (vertebral arteries, basilar artery, and posterior cerebral artery [PCA] P1 segment), and 34 had distal vessel occlusions other than MCA M2/M3 (ACA A1-A2, PCA P2). These patients were excluded from the study. As a result, 98 patients who underwent MT due to MCA M2 or M3 segment occlusion were included in the study.\u003c/p\u003e\u003cp\u003eThe following conditions were required for patients undergoing MT: presentation within the first six to eight hours from symptom onset, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 6 or higher, National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher, and the presence of appropriate indications for MT (5,8).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe following data of patients included in the study were retrospectively collected from hospital archives: demographic characteristics (age and sex), comorbidities, time elapsed since symptom onset, side of occlusion (right/left), level of occlusion (M2/M3), method used in MT (isolated aspiration, stent retriever, and aspiration combined therapy), occurrence of complications during the procedure, status of collateral circulation (good, moderate, or poor compared to the symmetrical side), hemorrhage status in control computed tomography (CT) at 24 hours (present/absent), modified Rankin Scale (mRS) score at three months, and Thrombolysis in Cerebral Infarction (TICI) grade.\u003c/p\u003e\n\u003ch3\u003eMT Procedure\u003c/h3\u003e\n\u003cp\u003eProcedures were performed under the guidance of monoplanar digital subtraction angiography (DSA) (Azurion 5 M20 Image Guided Therapy System Monoplane Ceiling/Floor Mounted, Philips Healthcare). Sedation was administered to most patients, whereas those who could not tolerate sedation were transitioned to general anesthesia. During the procedure, cardiac rhythm, pulse oximetry, and blood pressure were continuously monitored. Following completion of preoperative preparation and local anesthesia administration, vascular access was obtained predominantly through the right femoral artery (or left femoral artery in cases of occlusion) and, in patients with unsuitable anatomy, via the right brachial or right radial artery. Based on the access site, a 6\u0026ndash;8-French, 11-cm introducer was placed. Heparin was not routinely administered; however, in cases of catheter system thrombosis, 50\u0026ndash;80 IU/kg intravenous (IV) heparin was used. Through the introducer, a 6-French long sheath catheter (NeuronMax-Penumbra, Fubuki-Asahi, Benchmark BMX96-Penumbra, AXS Infinity LS Plus-Stryker) was advanced to an appropriate level in the distal ICA.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIsolated Aspiration\u003c/strong\u003e\u003cp\u003eIn cases where isolated aspiration was performed, an aspiration catheter (SOFIA 6F MicroVention-Terumo, AXS-Stryker, Neuron ACE64 max system-Penumbra, Neurocath-Taha Medical) was advanced over a microguidewire and microcatheter to the proximal portion of the clot through the long sheath. Manual aspiration was performed for 2 minutes using a 50-cc syringe. In cases where sufficient recanalization was achieved, the procedure was terminated. In cases of inadequate recanalization, the procedure was repeated and/or transitioned to the stent retriever technique.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCombined Technique (Stent Retriever and Aspiration)\u003c/strong\u003e\u003cp\u003eIn patients for whom the isolated aspiration method failed or was unsuitable, access to the thrombus level was achieved via the aspiration catheter using a microguidewire (Traxcess Microvention-Terumo, Hybrid Balt-Montmorency, Synchro-Stryker) and microcatheter (Rebar-Medtronic, Headway 21 MicroVention-Terumo). After the microguidewire reached the clot, it was removed, and a stent retriever was deployed through the microcatheter. Depending on the occlusion site and vascular anatomy at that level, in some patients, the stent was partially deployed distal to the clot to allow advancement of the aspiration catheter. In anatomically suitable patients, the stent was fully deployed and thrombectomy was performed. In patients with challenging anatomy, to minimize distal embolization and increase thrombectomy success, the aspiration catheter was held at the proximal level of MCA M2 to halt flow, and thrombectomy was carried out with the stent retriever under weak aspiration. In cases where recanalization was achieved on control angiograms, the procedure was concluded, while in those where recanalization could not be achieved, the intervention was repeated up to a maximum of five attempts.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eEvaluation of Outcomes\u003c/h3\u003e\n\u003cp\u003eTo assess the efficacy of MT, post-procedural TICI grades were recorded. TICI grades and occlusion levels were independently assessed by two interventional radiologists. A TICI grade of 0\u0026ndash;2a was considered inadequate revascularization, while a score of 2b\u0026ndash;3 was considered adequate revascularization. To assess clinical response, the mRS score at three months after treatment was recorded. An mRS score of 0\u0026ndash;2 was defined as successful treatment, and a score of 3\u0026ndash;6 was considered unsuccessful.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis of the data obtained from the study was performed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (minimum\u0026ndash;maximum) values, while categorical variables were presented as numbers and percentages. The normality of the data distribution was assessed using the Kolmogorov-Smirnov and Shapiro-Wilk tests. For normally distributed variables, Student\u0026rsquo;s t-test (for comparisons between two groups) and one-way analysis of variance (for comparisons among more than two groups) were used. For non-normally distributed continuous variables, the Mann-Whitney U test and Kruskal-Wallis H test were applied. To compare the distribution of categorical variables between groups, the Pearson chi-square test and, when necessary, Fisher\u0026rsquo;s exact test were used. Appropriate parametric and non-parametric tests were applied for the analysis of continuous variables such as the TICI grade, NIHSS score, and ASPECTS. Pearson and Spearman correlation coefficients were calculated to assess relationships between variables such as clinical success (90-day mRS score) and TICI grade. Suitable statistical tests were used to examine associations with mortality and complications. All hypothesis tests were conducted as two-tailed, and a p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the total 98 patients included in the study, 46 (46.9%) were male and 52 were female, with a mean age of 69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2 years for the entire cohort. The characteristics of all patients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The most frequently observed site of occlusion was the left MCA M2 segment (n\u0026thinsp;=\u0026thinsp;62, 61.2%). The mean ASPECT and NIHSS scores at presentation were 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 (range: 7\u0026ndash;10) and 14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 (range: 8\u0026ndash;28), respectively. On pre-procedural CT angiography, moderate collateralization (n\u0026thinsp;=\u0026thinsp;52, 53.1%) was most commonly observed. The combined method involving both stent retriever and aspiration was the most frequently employed MT technique (n\u0026thinsp;=\u0026thinsp;88, 89.8%). On control brain CT scans performed at 24 hours after the procedure, intracranial hemorrhage was detected in six patients as a complication.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic, clinical, and procedural characteristics of the patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;98\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46 (46.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (53.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocalization\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight MCA M2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft MCA M2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62 (61.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight MCA M3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (4.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft MCA M3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASPECTS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNIHSS score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCollateral status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor (type 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (36.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (type 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (53.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (type 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEndovascular treatment method\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (89.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIsolated aspiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComplication during procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemorrhage on control CT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (24.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eMCA: middle cerebral artery, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, CT: computed tomography\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eConsidering all patients, at 90 days after treatment, 70 cases (71.4%) achieved an mRS score between 0 and 2, indicating sufficient clinical success. The mean age of these 70 patients was 67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4 years (p\u0026thinsp;=\u0026thinsp;0.016). The overall mean time to presentation was 4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 hours, and this average was slightly lower (3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 hours) in patients with lower mRS scores (p\u0026thinsp;=\u0026thinsp;0.288). The mean ASPECTS for all included patients was 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, being recorded as 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 in the mRS 0\u0026ndash;2 group and 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 in the mRS 3\u0026ndash;6 group (p\u0026thinsp;=\u0026thinsp;0.001). Among patients with an overall mean NIHSS score of 14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2, the score was calculated to be 13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 in the mRS 0\u0026ndash;2 group and 16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 in the mRS 3\u0026ndash;6 group (p\u0026thinsp;=\u0026thinsp;0.072). Of the 70 patients with an mRS score of 0\u0026ndash;2, sufficient revascularization was achieved in 64 (91.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The combined technique, the most commonly preferred method (n\u0026thinsp;=\u0026thinsp;88, 89.8%), was used in 60 of the patients with an mRS score of 0\u0026ndash;2 (85.7%, p\u0026thinsp;=\u0026thinsp;0.028). Intracranial hemorrhage was observed in six patients (6.1%, p\u0026thinsp;=\u0026thinsp;0.033) who showed extravasation during the procedure and underwent immediate post-procedural control brain CT. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the relationship between clinical treatment outcomes and associated variables.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship of clinical treatment success and outcomes with variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003emRS score (0\u0026ndash;2)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;70\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003emRS score (3\u0026ndash;6)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll patients\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;98\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex (male)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (51.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46 (46.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to presentation, hours\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASPECTS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNIHSS score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTICI grade (2b\u0026ndash;3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64 (91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e80 (81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMethod (combined)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComplication during procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCollateral status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePoor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52 (53.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemorrhage on 24-hour control CT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64 (91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.306\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003emRS: modified Rankin Scale, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, TICI: Thrombolysis in Cerebral Infarction, CT: computed tomography\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn this study, technical procedural success was evaluated according to the TICI grade, with scores of 2b\u0026ndash;3 being considered successful. Among cases where TICI grades 2b\u0026ndash;3 recanalization was achieved (n\u0026thinsp;=\u0026thinsp;80, 81.6%), the mean time to presentation was 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 hours (p\u0026thinsp;=\u0026thinsp;0.074), and the mean ASPECTS was 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 (p\u0026thinsp;=\u0026thinsp;0.001). Mortality occurred within the first three months in 18 out of 98 patients. Ten of these patients had a TICI grade of 2b\u0026ndash;3 (12.5%, p\u0026thinsp;=\u0026thinsp;0.004). Other variables and findings based on the TICI recanalization grade are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship of technical success with variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTICI grade (2b\u0026ndash;3)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;80\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTICI grade (0\u0026ndash;2a)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex (male), n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.512\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to presentation, hours\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASPECTS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNIHSS score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.580\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMethod (combined), n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComplication during procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.303\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCollateral status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePoor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42 (52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (55.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemorrhage on control CT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.248\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMortality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eTICI: Thrombolysis in Cerebral Infarction, ASPECTS: Alberta Stroke Program Early Computed Tomography Score, NIHSS: National Institutes of Health Stroke Scale, CT: computed tomography\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigures \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e present the imaging of patients who underwent MT for MCA M2 or M3 occlusion.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe most significant finding of this study, which retrospectively evaluated the outcomes, efficacy, and safety of MT in 98 patients with AIS presenting with occlusion in the MCA M2 and/or M3 segments, is the achievement of a high technical success rate (81.6%) indicating adequate revascularization (TICI grades 2b\u0026ndash;3), and a high functional independence rate (71.4%), indicating favorable clinical outcomes (mRS at three months\u0026thinsp;\u0026le;\u0026thinsp;2). These results are generally consistent with the existing literature, including several randomized clinical trials since 2015 focusing on LVOs that included a small number of patients with DOs (MR CLEAN, REVASCAT, ESCAPE, EXTEND-IA, and SWIFT PRIME studies), which have demonstrated the efficacy and safety of MT [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the limited number of patients with occlusion in distal segments such as MCA M2 and M3 in these studies raises uncertainty about the generalizability of their findings to these specific segments. This limitation underscores the importance of our study, as it focuses specifically on this patient subgroup.\u003c/p\u003e\u003cp\u003eDifferences in patient selection criteria, MT techniques employed, and procedural timing in various studies may explain the variation in the adequate revascularization rate (TICI grades 2b\u0026ndash;3) of 81.6% in our study. This rate is higher than in some major LVO-focused trials that guide clinical practice (MR RESCUE, IMS III, REVASCAT, ESCAPE, and MR CLEAN) and lower than in others (EXTEND IA, SWIFT, NASA, and TREVO 2) [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of revascularization and functional independence rates between our study and major studies focusing on large vessel occlusions and evaluating the efficacy of mechanical thrombectomy in acute ischemic stroke\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRevascularization (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFunctional independence (mRS score\u0026thinsp;\u0026le;\u0026thinsp;2) (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMR RESCUE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMS III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eREVASCAT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESCAPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMR CLEAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEXTEND IA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWIFT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNASA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTREVO 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e81.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e71.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003emRS: modified Rankin Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMore specifically, our revascularization rate was better than those reported by Flores et al. (78.5%) and Sarraj et al. (78%) in studies assessing the efficacy of MT in occlusions of DOs or the MCA M2 segment; however, it was lower than the rates reported by Coutinho et al. (85%), Dorn et al. (93%), and Bhogal et al. (90.5%) [\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). These varying technical success rates highlight the ongoing debate in the literature regarding the optimal treatment approach for DOs.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of revascularization and functional independence rates between our study and major studies focusing on distal occlusions (MCA M2) and evaluating the efficacy of mechanical thrombectomy in acute ischemic stroke\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRevascularization (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFunctional independence (mRS score\u0026thinsp;\u0026le;\u0026thinsp;2) (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlores et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoutinho et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSarraj et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDorn et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBhogal et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e98\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e81.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e71.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003emRS: modified Rankin Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eExcept for the EXTEND IA study (71%), our functional independence rate (71.4%) was higher than that of all other LVO-focused studies. This result can be attributed to the fact that our study specifically targeted DOs (MCA M2 and M3) and to the better prognosis generally associated with distal branch occlusions compared to LVOs (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Compared with other studies evaluating MT in MCA M2 segment occlusions, our study yielded more favorable results in terms of functional independence. This may stem from differences in patient selection criteria, MT techniques applied, or other clinical management factors (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePrognostic Factors\u003c/h2\u003e\u003cp\u003eIn this study, the mean ASPECTS of the functionally independent group (mRS\u0026thinsp;\u0026le;\u0026thinsp;2) was found to be significantly higher than that of the dependent group. This finding supports existing literature indicating that a higher ASPECTS (indicating less affected parenchyma and smaller established infarct zones) is associated with better clinical outcomes. Furthermore, the fact that 91.4% of patients with adequate revascularization belonged to the functionally independent group demonstrates that successful recanalization is a critical determinant of clinical improvement. This finding supports current guidelines recommending MT as a treatment option in M2 occlusions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eComplications and Mortality\u003c/h2\u003e\u003cp\u003eIn our study, complications occurred in 6.1% of procedures, and intracranial hemorrhage was detected in 24.5% of cases. These rates are similar to or lower than those reported in other studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and it can be explained by our center\u0026rsquo;s experience and careful patient selection.\u003c/p\u003e\u003cp\u003eThe mortality rate in our study was 18.4%, which is similar to some reports in the literature while differing from others [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These differences may be attributable to variations in patient populations, comorbidities, and differences in management during follow-up. The lower mortality rate among patients with adequate revascularization further emphasizes the importance of successful recanalization for quality of life and survival.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations of the Study\u003c/h2\u003e\u003cp\u003eOne of the notable strengths of this study lies in its specific focus on occlusions in the MCA M2 and M3 segments, a patient group that has often been underrepresented in previous large-scale trials. Another strength is its reflection of real-world clinical practice, as the data were derived from routine patient care rather than a controlled trial environment. The study also benefits from a sufficiently large sample size. However, several limitations should be acknowledged, including the retrospective and single-center design. In addition, as all patients were diagnosed and treated at a dedicated stroke center without receiving IV thrombolysis, the study could not evaluate the comparative efficacy of IV thrombolysis in patients with DOs.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis retrospective study provides important insight into the efficacy and safety of MT in patients with AIS presenting with MCA M2 and M3 segment occlusions. Our findings offer significant implications for clinical practice, suggesting that MT may be a safe and effective treatment method for selected cases in this patient population. However, further prospective studies are necessary to generalize these findings to broader populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMiddle cerebral artery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMechanical thrombectomy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTICI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThrombolysis in Cerebral Infarction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003emRS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emodified Rankin Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASPECT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlberta Stroke Program Early Computed Tomography Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLVO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLarge vessel occlusion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed tomography angiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eposterior cerebral artery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNIHSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Institutes of Health Stroke Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDigital subtraction angiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternal cerebral artery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEK, SA, MT, VK, AG and EC designed the study. MT and EK contributed equally to this work. EK analyzed and interpreted the data with AG, AAO, VK, EC, MT and EU. EK and MT wrote the manuscript. AAO, EU provided scientific support and valuable advice. All authors proofread the manuscript and revised it critically. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they received no funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All data that are relevant for the study are included in this published article. Further datasets analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical approval for this study was obtained from the Ethics Committee of Harran University. Because the study was retrospective in nature and conducted using patient records, the Ethics Committee waived the requirement for written informed consent to participate, in accordance with national regulations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKatan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38:208\u0026ndash;11. https://doi.org/10.1055/s-0038-1649503.\u003c/li\u003e\n\u003cli\u003ePowers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49. https://doi.org/10.1161/STR.0000000000000158.\u003c/li\u003e\n\u003cli\u003eJadhav AP, Desai SM, Jovin TG. Indications for Mechanical Thrombectomy for Acute Ischemic Stroke. Neurology. 2021;97 20_Supplement_2. https://doi.org/10.1212/WNL.0000000000012801.\u003c/li\u003e\n\u003cli\u003ePsychogios M, Brehm A, Ribo M, Rizzo F, Strbian D, R\u0026auml;ty S, et al. Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels. N Engl J Med. 2025;392:1374\u0026ndash;84. https://doi.org/10.1056/NEJMoa2408954.\u003c/li\u003e\n\u003cli\u003eFransen PS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014;15:343. https://doi.org/10.1186/1745-6215-15-343.\u003c/li\u003e\n\u003cli\u003eMolina CA, Chamorro A, Rovira \u0026Agrave;, de Miquel A, Serena J, Roman LS, et al. REVASCAT: A Randomized Trial of Revascularization with Solitaire FR\u0026reg; Device vs. Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight-Hours of Symptom Onset. Int J Stroke. 2015;10:619\u0026ndash;26. https://doi.org/10.1111/ijs.12157.\u003c/li\u003e\n\u003cli\u003eIssa Y, Kempeneers MA, Bruno MJ, Fockens P, Poley J-W, Ahmed Ali U, et al. Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis. JAMA. 2020;323:237. https://doi.org/10.1001/jama.2019.20967.\u003c/li\u003e\n\u003cli\u003eCampbell BC V., Mitchell PJ, Yan B, Parsons MW, Christensen S, Churilov L, et al. A Multicenter, Randomized, Controlled Study to Investigate Extending the Time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial Therapy (EXTEND-IA). Int J Stroke. 2014;9:126\u0026ndash;32. https://doi.org/10.1111/ijs.12206.\u003c/li\u003e\n\u003cli\u003eSaver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, et al. Solitaire\u003csup\u003eTM\u003c/sup\u003e with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) Trial: Protocol for a Randomized, Controlled, Multicenter Study Comparing the Solitaire Revascularization Device with IV tPA with IV t. Int J Stroke. 2015;10:439\u0026ndash;48. https://doi.org/10.1111/ijs.12459.\u003c/li\u003e\n\u003cli\u003eNogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380:1231\u0026ndash;40. https://doi.org/10.1016/S0140-6736(12)61299-9.\u003c/li\u003e\n\u003cli\u003eKidwell CS, Jahan R, Alger JR, Schaewe TJ, Guzy J, Starkman S, et al. Design and Rationale of the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) Trial. Int J Stroke. 2014;9:110\u0026ndash;6. https://doi.org/10.1111/j.1747-4949.2012.00894.x.\u003c/li\u003e\n\u003cli\u003eBroderick JP, Berkhemer OA, Palesch YY, Dippel DWJ, Foster LD, Roos YBWEM, et al. Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke. Stroke. 2015;46:3416\u0026ndash;22. https://doi.org/10.1161/STROKEAHA.115.011397.\u003c/li\u003e\n\u003cli\u003eZaidat OO, Castonguay AC, Gupta R, Sun C-HJ, Martin C, Holloway WE, et al. North American Solitaire Stent Retriever Acute Stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg. 2018;10 Suppl 1:i45\u0026ndash;9. https://doi.org/10.1136/neurintsurg-2013-010895.rep.\u003c/li\u003e\n\u003cli\u003eBhogal P, B\u0026uuml;cke P, Aguilar P\u0026eacute;rez M, Ganslandt O, B\u0026auml;zner H, Henkes H. Mechanical Thrombectomy for M2 Occlusions: A Single-Centre Experience. Interv Neurol. 2017;6:117\u0026ndash;25. https://doi.org/10.1159/000458161.\u003c/li\u003e\n\u003cli\u003eSarraj A, Parsons M, Bivard A, Hassan AE, Abraham MG, Wu T, et al. Endovascular Thrombectomy Versus Medical Management in Isolated M2 Occlusions: Pooled Patient‐Level Analysis from the EXTEND‐IA Trials, INSPIRE, and SELECT Studies. Ann Neurol. 2022;91:629\u0026ndash;39. https://doi.org/10.1002/ana.26331.\u003c/li\u003e\n\u003cli\u003eFlores A, Tomasello A, Cardona P, de Miquel MA, Gomis M, Garcia Bermejo P, et al. Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience. J Neurointerv Surg. 2015;7:234\u0026ndash;7. https://doi.org/10.1136/neurintsurg-2014-011100.\u003c/li\u003e\n\u003cli\u003eCoutinho JM, Liebeskind DS, Slater L-A, Nogueira RG, Baxter BW, Levy EI, et al. Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies. Am J Neuroradiol. 2016;37:667\u0026ndash;72. https://doi.org/10.3174/ajnr.A4591.\u003c/li\u003e\n\u003cli\u003eSakai Y, Yoshikawa G, Koizumi S, Ishikawa O, Saito A, Sato K. Complete Recanalization in Mechanical Thrombectomy Is Associated with Favorable Functional Outcome for M2 Occlusions. J Neuroendovascular Ther. 2023;17:oa.2022-0057. https://doi.org/10.5797/jnet.oa.2022-0057.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute ischemic stroke, mechanical thrombectomy, middle cerebral artery, endovascular treatment, revascularization","lastPublishedDoi":"10.21203/rs.3.rs-7273475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7273475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAcute 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.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eIn 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 98 patients included in the study, 46.9% were male, and the mean age was 69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2 years. The rate of technical success (TICI grades 2b\u0026ndash;3) was 81.6% (n\u0026thinsp;=\u0026thinsp;80). Clinical success (mRS: 0\u0026ndash;2) was achieved in 71.4% (n\u0026thinsp;=\u0026thinsp;70) of the patients. The mean age in the group with clinical success (mRS score: 0\u0026ndash;2) was significantly lower than in the other group (67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4 vs. 67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4, p\u0026thinsp;=\u0026thinsp;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\u0026thinsp;=\u0026thinsp;0.033), while the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was higher (9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 vs. 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the National Institutes of Health Stroke Scale score was lower (13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 vs. 16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2, p\u0026thinsp;=\u0026thinsp;0.072). In the group with high technical success (TICI grades 2b\u0026ndash;3), compared to those without (TICI grades 0\u0026ndash;2a), the ASPECTS was higher (9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 vs. 8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;0.001), and the mortality rate was lower (12.5% vs. 44.4%, p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:25:42","doi":"10.21203/rs.3.rs-7273475/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebee1e28-b65e-4bf7-a172-7a419f5c9159","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T08:13:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:25:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7273475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7273475","identity":"rs-7273475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}