Real-world characteristics of endovascular treatment for middle cerebral artery M2 segment occlusion in Fukushima Prefecture: a prospective multicenter registry study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke due to middle cerebral artery M2 segment occlusion (n=34). Intervention: Endovascular treatment (EVT) vs. Medical management (MM). Primary outcome: Functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days.

Q: What does this research mean for the field?

In older rural acute ischemic stroke patients with middle cerebral artery M2 segment occlusion, endovascular treatment achieved 90-day functional independence in 40.0% of patients compared to 45.8% with medical management. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Takuya Maeda; Takao Kojima; Mudathir S. Bakhit; Haruhiko Kikuta; Yuhei Ito; Kiyoshi Saito; Masazumi Fujii

doi:10.5387/fms.26-00026

January 1, 2026FUKUSHIMA JOURNAL OF MEDICAL SCIENCEOpen Access

Real-world characteristics of endovascular treatment for middle cerebral artery M2 segment occlusion in Fukushima Prefecture: a prospective multicenter registry study

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Key result

EVT shows no functional independence benefit over medical management in rural M2 occlusion.

n=34

Why the study?

The role of endovascular treatment (EVT) in middle cerebral artery M2 segment occlusion remained inconclusive, particularly in rural areas with aging populations.

Does endovascular treatment improve 90-day functional independence and safety compared to medical management in elderly patients with acute middle cerebral artery M2 segment occlusion in a rural Japanese cohort?

Key Points

To characterize real-world clinical features, workflow metrics, and outcomes of endovascular treatment versus medical management for acute middle cerebral artery M2 segment occlusion in a rural Japanese cohort.
Prospective multicenter registry study across 11 stroke centers in Fukushima Prefecture, Japan, evaluating patients presenting within 24 hours of onset between July 2020 and June 2022.
Included 34 patients with acute M2 segment occlusion classified by initial strategy into endovascular treatment (EVT, n=10) or medical management (MM, n=24).
Assessed functional independence (modified Rankin Scale 0-2) at 90 days, symptomatic intracerebral hemorrhage within 72 hours, 90-day mortality, and reperfusion rates.
Functional independence at 90 days occurred in 40.0% (4/10) of the EVT group and 45.8% (11/24) of the MM group.
Symptomatic intracerebral hemorrhage within 72 hours occurred in 0% (0/10) of EVT patients and 4.2% (1/24) of MM patients, while 90-day mortality was 20.0% (2/10) versus 12.5% (3/24).
Successful reperfusion was achieved in 70.0% (7/10) of EVT patients, with a median puncture-to-reperfusion time of 81 minutes and intravenous rt-PA usage of 30.0% compared to 54.2% in the MM group.

Study Design

Type

Observational (n=34)

Multicenter

Yes

Structured PICO

Does endovascular treatment improve 90-day functional independence and safety compared to medical management in elderly patients with acute middle cerebral artery M2 segment occlusion in a rural Japanese cohort?

P

Population

34 older adults (median age 81 years, 50.0% female) with acute ischemic stroke due to middle cerebral artery M2 segment occlusion presenting within 24 hours across 11 stroke centers in Fukushima Prefecture, followed for 90 days.

E

Exposure

Endovascular treatment (EVT, n=10), predominantly using a combined stent retriever and aspiration catheter technique (70.0%) or stent retriever alone (20.0%), with intravenous recombinant tissue-type plasminogen activator (rt-PA) administered in 30.0% of cases.

C

Comparator

Medical management (MM, n=24), including intravenous recombinant tissue-type plasminogen activator (rt-PA) administered in 54.2% of cases, determined at each institution in accordance with 2020 Japanese national guidelines.

O

Outcome

Functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days post-treatment and the incidence of symptomatic intracerebral hemorrhage (ICH) within 72 hours.hard clinical

Main Result

Absolute Event Rate: 40% vs 45.8%

In a rural Japanese cohort with acute M2 segment occlusion, advanced patient age, delayed reperfusion, and pre-stroke dependency limited 90-day functional independence across both endovascular and medical management groups, highlighting the need for locally tailored patient selection.

Limitations

Small sample size precluding statistical comparison of treatment efficacy
Non-randomized design and locally determined treatment strategy introducing potential selection bias
Lack of centralized imaging adjudication
Absence of perfusion imaging to determine treatment eligibility
Registry did not capture factors determining prehospital transport destination
Small sample size precludes statistical comparison of treatment efficacy
Non-randomized design and locally determined treatment strategy at each institution preclude causal interpretation and may have introduced selection bias
Lack of centralized imaging adjudication and absence of perfusion imaging may have contributed to treatment heterogeneity
LKW-to-door time was longer in the EVT group, and the registry did not capture factors determining the transport destination

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May not support routine endovascular treatment in rural elderly M2 occlusion; leaves open tailored selection in prospective studies.

Abstract

BACKGROUND: The role of endovascular treatment (EVT) in middle cerebral artery M2 segment occlusion remains inconclusive, particularly in rural areas with aging populations. We characterized EVT and medical management (MM) for M2 occlusion in Fukushima Prefecture, Japan, and explored clinical factors associated with outcomes. METHODS: We analyzed a prospective multicenter acute ischemic stroke registry (July 2020-June 2022; 11 stroke centers). Patients with M2 occlusion were classified into EVT or MM groups; characteristics, workflow metrics, and outcomes were described and referenced against previously reported series. RESULTS: Among 210 patients, 34 had M2 occlusion (EVT, n=10; MM, n=24). At 90 days, functional independence (modified Rankin Scale [mRS] 0-2) was 40.0% (EVT) and 45.8% (MM); symptomatic intracerebral hemorrhage, 0% and 4.2%; mortality, 20.0% and 12.5%; successful reperfusion, 70.0% (EVT). Both groups were older than in previous reports (median 81 years). The EVT group also received rt-PA less often (30.0%) and had longer puncture-to-reperfusion times (81 minutes), whereas the MM group had lower pre-stroke independence (67%) and higher mortality, despite lower severity. CONCLUSION: Advanced age, delayed reperfusion, and greater pre-stroke dependency distinguished this rural cohort from previous reports and likely account for its outcomes, underscoring the need for locally tailored patient selection for EVT in M2 occlusion.

Discussion

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Cite This Study

Maeda et al. (2026) conducted an observational in Acute ischemic stroke due to middle cerebral artery M2 segment occlusion (n=34). Endovascular treatment (EVT) vs. Medical management (MM) was evaluated on Functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days. Endovascular treatment achieved 90-day functional independence (mRS 0-2) in 40.0% of rural M2 occlusion patients compared to 45.8% with medical management.

synapsesocial.com/papers/6af73ac79badce7b6084da02 https://doi.org/10.5387/fms.26-00026

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Real-world characteristics of endovascular treatment for middle cerebral artery M2 segment occlusion in Fukushima Prefecture: a prospective multicenter registry study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Real-world characteristics of endovascular treatment for middle cerebral artery M2 segment occlusion in Fukushima Prefecture: a prospective multicenter registry study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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