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Association Between Occluded Vessel Diameter and Clinical Outcomes of Mechanical Thrombectomy for M2 Occlusion
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DOI：10.1007/s00062-026-01639-3.png)
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Abstract
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Background The association between occluded vessel diameter measured using pre-recanalization digital subtraction angiograms and clinical outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion remains unclear. Methods Consecutive patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion at our institution between January 2020 and December 2024 were retrospectively analyzed. Based on pre-recanalization digital subtraction angiograms, patients were classified as having large M2 occlusion (LM2O, >= 1.7 mm) or small M2 occlusion (SM2O, < 1.7 mm). Favorable 90-day outcome, defined as modified Rankin Scale 0-2 or recovery to pre-stroke level, were compared between the two groups. Results There were 56 (58.3%) LM2O patients and 40 (41.7%) SM2O patients. Median occluded vessel diameter was 1.85 mm (IQR 1.78-2.11) for LM2O and 1.52 mm (IQR 1.43-1.62) for SM2O. LM2O patients were more likely to have dominant M2 occlusion (67.9% vs. 40.0%, P = 0.012), favorable outcome (62.5% vs. 25.0%; OR 6.67, 95% CI 2.59-17.15; P < 0.001), and first-pass effect (48.2% vs. 17.5%; OR 4.39, 95% CI 1.66-11.57; P = 0.002). In multivariable analysis, occluded vessel diameter >= 1.7 mm was independently associated with favorable outcome (OR 10.50, 95% CI 3.17-35.0; P < 0.001). Patients with a catheter-to-vessel ratio < 1.0 experienced higher first-pass effect more frequently than those with a catheter-to-vessel ratio >= 1.0 (46.8% vs. 24.5%; P = 0.032). Conclusions Occluded M2 vessel diameter >= 1.7 mm may be associated with favorable 90-day outcome in patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion.
Keywords:
Ischemic stroke
Medium vessel
M2 occlusion
Outcomes
Thrombectomy
Vessel diameter
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