Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke.

Räty, Silja; Nguyen, Thanh N; Nagel, Simon; Strambo, Davide; Michel, Patrik; Herweh, Christian; Qureshi, Muhammad M; Abdalkader, Mohamad; Virtanen, Pekka; Olive-Gadea, Marta; Ribo, Marc; Psychogios, Marios; Nguyen, Anh; Kuramatsu, Joji B; Haupenthal, David; Köhrmann, Martin; Deuschl, Cornelius; Escolà, Jordi Kühne; Demeestere, Jelle; Lemmens, Robin; ... (2024). Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke. Journal of stroke, 26(2), pp. 290-299. Korean Stroke Society 10.5853/jos.2024.00458

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BACKGROUND AND PURPOSE

Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone.

METHODS

From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0-1) and independent outcome (mRS 0-2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment.

RESULTS

Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3-P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79-1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05-2.12), sICH (aOR 2.87, 95% CI 1.23-6.72), and mortality (aOR 1.77, 95% CI 1.07-2.95).

CONCLUSION

Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Kaesmacher, Johannes, Mujanović, Adnan, Fischer, Urs Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2287-6391

Publisher:

Korean Stroke Society

Language:

English

Submitter:

Pubmed Import

Date Deposited:

06 Jun 2024 12:17

Last Modified:

06 Jun 2024 12:25

Publisher DOI:

10.5853/jos.2024.00458

PubMed ID:

38836276

Uncontrolled Keywords:

Endovascular thrombectomy Intravenous thrombolysis Posterior cerebral artery Posterior circulation stroke

BORIS DOI:

10.48350/197585

URI:

https://boris.unibe.ch/id/eprint/197585

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