Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy
Authors: Yedavalli Vivek , Salim Hamza Adel , Musmar Basel , Adeeb Nimer , El Naamani Kareem , Henninger Nils , Sundararajan Sri Hari , Kühn Anna Luisa , Khalife Jane , Ghozy Sherief , Scarcia Luca , Tan Benjamin YQ , Regenhardt Robert W , Heit Jeremy J , Cancelliere Nicole M , Bernstock Joshua D , Rouchaud Aymeric , Fiehler Jens , Sheth Sunil , Puri Ajit S , Dyzmann Christian , Colasurdo Marco , Barreau Xavier , Renieri Leonardo , Filipe João Pedro , Harker Pablo , Radu Răzvan Alexandru , Abdalkader Mohamad , Klein Piers , Marotta Thomas R , Spears Julian , Ota Takahiro , Mowla Ashkan , Jabbour Pascal , Biswas Arundhati , Clarençon Frédéric , Siegler James E , Nguyen Thanh N , Varela Ricardo , Baker Amanda , Essibayi Muhammed Amir , Altschul David , Gonzalez Nestor R , Möhlenbruch Markus A , Costalat Vincent , Gory Benjamin , Stracke Christian Paul , Aziz-Sultan Mohammad Ali , Hecker Constantin , Shaikh Hamza , Liebeskind David S , Pedicelli Alessandro , Alexandre Andrea M , Tancredi Illario , Faizy Tobias D , Kalsoum Erwah , Lubicz Boris , Patel Aman B , Pereira Vitor Mendes , Guenego Adrien , Dmytriw Adam A 
Published: September 2024

Background: Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. Methods: This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12–36 h post-MT. Results: Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. Conclusions: FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.