Key result
Onset-to-puncture time during EVT was not associated with 90-day mRS 0-2 in MCA-M2 occlusion, unlike in LVO.
Why the study?
The applicability of time dependency of endovascular treatment to middle cerebral artery M2 occlusion stroke remained unclear.
Does shorter time to endovascular treatment (onset-to-puncture and onset-to-reperfusion) improve 90-day functional independence (mRS 0-2) in acute ischemic stroke patients with MCA-M2 occlusion compared to large vessel occlusion?
Observational (n=2,846)
Yes
Does shorter time to endovascular treatment (onset-to-puncture and onset-to-reperfusion) improve 90-day functional independence (mRS 0-2) in acute ischemic stroke patients with MCA-M2 occlusion compared to large vessel occlusion?
Unlike in large vessel occlusion where treatment delay consistently worsens outcomes after endovascular thrombectomy, the time-dependency of clinical outcomes in MCA-M2 occlusion is less consistent and varies by outcome definition.
Answers are grounded in this paper and cite their sources.
Time metrics may not influence outcomes in MCA-M2 occlusion; challenges extension of large vessel occlusion time-outcome relationships.
Background Whether time dependency could apply to middle cerebral artery (MCA) M2 occlusion stroke remains unclear. Objectives To compare the association of time to EVT and clinical outcomes between large vessel occlusion (LVO) and MCA M2 occlusion patients. Design A pool analysis of DEVT (Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients with Acute Ischemic Stroke), RESCUE BT (Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke) and MARVEL (Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke) trial. Methods 2,846 EVT-treated patients with onset-to-puncture (OTP) ≤24 hours were included. Associations of OTP and onset-to-reperfusion time (OTR) with clinical outcomes were evaluated in patients with LVO and MCA-M2 occlusion separately. The primary effectiveness outcome was 90-day modified Rankin Scale (mRS) score 0–2. Secondary effectiveness outcomes included ordinal mRS score and mRS score 0–1 at 90 days. Safety outcomes were 90-day mortality and symptomatic intracranial hemorrhage within 48 hours. Results Among 2,846 eligible patients, 364 had MCA-M2 occlusion. In the LVO group, longer OTP and OTR were consistently associated with worse functional outcomes. In the MCA-M2 group, OTP was not associated with mRS score 0–2 (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.94–1.03, P =0.495) or ordinal mRS shift ( P =0.124), although it was associated with lower odds of mRS 0–1 ( P =0.036). Similarly, OTR was not associated with functional independence in MCA-M2 occlusion, but longer OTR was associated with worse ordinal mRS outcomes and lower odds of mRS 0–1. Conclusions Treatment delay was consistently associated with worse outcomes after EVT in LVO. In MCA-M2 occlusion, the associations between time metrics and clinical outcomes demonstrated less consistent across different outcome definitions.
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ZHAO et al. (2026) conducted an observational in Acute ischemic stroke due to large vessel occlusion or middle cerebral artery M2 occlusion (n=2,846). Onset-to-puncture (OTP) and onset-to-reperfusion time (OTR) in endovascular treatment vs. Shorter time to treatment / LVO vs MCA-M2 occlusion was evaluated on 90-day modified Rankin Scale (mRS) score 0–2 (aOR 0.98, 95% CI 0.94-1.03, p=0.495). Onset-to-puncture time during EVT was not associated with 90-day mRS 0-2 in MCA-M2 occlusion, unlike in LVO.
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