Safety first: A comparative study of mechanical thrombectomy techniques for M2 occlusions - stent-retriever thrombectomy (SRT) vs. first stenting without retrieval (FRESH).

BACKGROUND

The most appropriate method for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to M2 segment middle cerebral artery (MCA) occlusion remains unclear. Hence, this study aimed to investigate the benefits of first stenting without retrieval (FRESH) vs. stent-retriever thrombectomy (SRT) for treating patients with M2 occlusion-associated AIS.

METHODS

The data of patients who underwent MT for AIS at our institution between January 2019 and December 2023 were reviewed. Treatment variables, clinical outcomes, and complications were analyzed.

RESULTS

Thirty-five patients with M2 MCA occlusion of the anterior circulation were included. Among these patients, 20 (57.1 %) underwent SRT, whereas 15 (42.9 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (35 vs. 41.5 min, p < 0.001). Asymptomatic intracranial hemorrhage was significantly more common in the SRT group than in the FRESH group (18.8 % vs. 0 %, p = 0.027). The FRESH group was more likely to experience both favorable clinical outcomes (modified Rankin score [mRS]: 0-2; 86.7 % vs. 55 %, respectively, p = 0.069) and excellent clinical outcomes (mRS: 0-1; 66.7 % vs. 25 %, p = 0.014).

CONCLUSION

The FRESH technique is a more efficient method for minimizing procedural risk while achieving recanalization in the treatment of patients with acute M2 occlusions.