• Salam Findakly, Julian Maingard, Kevin Phan, Christen D Barras, Ashu Jhamb, Ronil Chandra, Vincent Thijs, Mark Brooks, and Hamed Asadi.
• Monash Health, Melbourne, Victoria, Australia.
• Intern Med J. 2020 May 1; 50 (5): 530-541.

BackgroundEndovascular clot retrieval (ECR) is the standard of care for acute ischaemic stroke due to large vessel occlusion. However, isolated occlusion of the M2 segment of the middle cerebral artery (MCA) was underrepresented in the landmark trials.AimsGiven the potential treatment benefit associated with M2 MCA occlusions, we aimed to evaluate the outcome of patients undergoing ECR for M2 occlusion.MethodsWe conducted a systematic review and meta-analysis of the available literature that included patients with M2 MCA occlusions who underwent ECR. Successful reperfusion was defined as a treatment in cerebral ischaemia score of 2b-3. Good outcome was defined as a modified Rankin Scale score ≤ 2. We also analysed complications such as post-procedure symptomatic intracranial haemorrhage and mortality at 3 months.ResultsFifteen studies including 1105 patients with isolated M2 occlusions were analysed. Successful reperfusion occurred in 75.4% (95% confidence interval (CI) 67.7-84.1%) of patients; good outcome was observed in 58.3% (95% CI 51.7-63.8% of patients. The rate of symptomatic intracranial haemorrhage was 5.1% (95% CI 4.2-8.3%), and 3-month mortality rate was 12.2% (95% CI 10.4-16.3%).ConclusionThe outcomes of ECR treatment of M2 occlusions are favourable, with good safety profile. Comparison to medical management from large registries or randomised controlled trials is warranted.© 2019 Royal Australasian College of Physicians.

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