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Research ArticleNeurointervention
Open Access

Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes

T.A. Tomsick, J. Carrozzella, L. Foster, M.D. Hill, R. von Kummer, M. Goyal, A.M. Demchuk, P. Khatri, Y. Palesch, J.P. Broderick, S.D. Yeatts, D.S. Liebeskind and for the IMS III Investigators
American Journal of Neuroradiology January 2017, 38 (1) 84-89; DOI: https://doi.org/10.3174/ajnr.A4979
T.A. Tomsick
aFrom the Department of Radiology (T.A.T., J.C.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
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J. Carrozzella
aFrom the Department of Radiology (T.A.T., J.C.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio
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L. Foster
bDepartment of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
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M.D. Hill
cCalgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Medicine, Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
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R. von Kummer
dDepartment of Neuroradiology (R.v.K.), Dresden University Stroke Center, Universitätsklinikum Carl Gustav Carusan deTechnischen Universität Dresden, Dresden, Germany
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M. Goyal
eDepartment of Radiology and Clinical Neurosciences (M.G.), University of Calgary, Calgary, Alberta, Canada
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A.M. Demchuk
cCalgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Medicine, Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
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P. Khatri
fDepartment of Neurology (P.K., J.P.B.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
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Y. Palesch
bDepartment of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
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J.P. Broderick
fDepartment of Neurology (P.K., J.P.B.), University of Cincinnati Academic Health Center, Cincinnati, Ohio
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S.D. Yeatts
bDepartment of Biostatistics, Bioinformatics, and Epidemiology (L.F., Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina
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D.S. Liebeskind
gUniversity of California Los Angeles Stroke Center (D.S.L.), Los Angeles, California.
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  • Fig 1.
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    Fig 1.

    A, Right M1 trunk gives rise to the ATA with the posterior temporal branch filling on microcatheter injection. B, Lateral view baseline common carotid arteriogram confirms mid- and posterior temporal lobe cortical supply from the patent posterior temporal artery.

  • Fig 2.
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    Fig 2.

    A, Anteroposterior: short M1 trunk with no ATA arising is shown. An isolated M2 holotemporal branch originates, simulating and giving origin to the ATA. It then exits the insular cistern, with multiple middle and posterior temporal arteries draping over and supplying the remainder of the temporal lobe (B). B, Lateral view common carotid arteriogram confirms filling of the holotemporal branch, with no other MCA branches filling.

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    Fig 3.

    Composite diagram of M1-M2 trunk anatomy based on IMS III post hoc analysis. The M1 trunk proximal to the lenticulostriate arteries (LS) is termed “M1P.” The anterior temporal artery arises from the holotemporal M2 branch (HoT). The M2 trunk is a continuation of the distal M1 trunk, beyond a holotemporal (HoT) or posterior temporal M2 branch. The M2 trunk divides into M2 divisions (M2 Div) or branches. M2 divisions divide further into M2 branches.

Tables

  • Figures
  • mRS 0–2 outcomes for 79 evaluable M2 trunk, division, and branch occlusion grouped according to mTICI 0–1, 2a, 2b–3 reperfusion gradea

    mTICI GradeM2 Trunk (n = 9)M2 Division (n = 42)M2 Branch (n = 28)
    N% mRS 0–2N% mRS 0–2N% mRS 0–2
    0–120601136.4
    2a101866.7922.2
    2b–36b5018b44.4837.5
    • ↵a This table uses only the evaluable sample.

    • ↵b mTICI 3: n = 1.

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American Journal of Neuroradiology: 38 (1)
American Journal of Neuroradiology
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T.A. Tomsick, J. Carrozzella, L. Foster, M.D. Hill, R. von Kummer, M. Goyal, A.M. Demchuk, P. Khatri, Y. Palesch, J.P. Broderick, S.D. Yeatts, D.S. Liebeskind, for the IMS III Investigators
Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes
American Journal of Neuroradiology Jan 2017, 38 (1) 84-89; DOI: 10.3174/ajnr.A4979

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Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes
T.A. Tomsick, J. Carrozzella, L. Foster, M.D. Hill, R. von Kummer, M. Goyal, A.M. Demchuk, P. Khatri, Y. Palesch, J.P. Broderick, S.D. Yeatts, D.S. Liebeskind, for the IMS III Investigators
American Journal of Neuroradiology Jan 2017, 38 (1) 84-89; DOI: 10.3174/ajnr.A4979
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