Bilateral posterior cerebral artery infarction

Ryan, Davinia; Murphy, Sinéad M.; Hennessey, Michael J

doi:10.1136/bcr.03.2010.2798

Cited by 6 publications

(6 citation statements)

References 4 publications

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“…In other cohort subgroup analysis, the median (IQR) NIHSS score did not decrease significantly from admission to discharge in patients with an mTICI of 2a or lower reperfusion in the mechanical thrombectomy cohort (from 9 [5][6][7][8][9][10][11][12][13] to 5 [2][3][4][5][6][7][8][9][10][11] points; P = .13) (eFigure 4 in the Supplement) and in patients who were not eligible for IVT in the standard medical treatment cohort (from 2 [1][2][3][4] to 2 [0-4] points; P = .39) (eFigure 5 in the Supplement).…”

Section: Clinical and Functional End Pointsmentioning

confidence: 82%

“…27 However, typical symptoms of infarcts in the territory of the PCA, such as hemianopia, may be associated with substantial restrictions in quality of life. 9 The NIHSS score is weighted toward anterior circulation deficits and does not represent the entire spectrum of posterior circulation stroke symptoms that substantially lower NIHSS cutoff values for estimating long-term outcomes compared with the anterior circulation. 28 On the basis of this systematic exclusion of patients for whom acute reperfusion therapies could be beneficial, 29 a considerable number of patients are discharged with poor outcomes despite low NIHSS scores.…”

Section: Discussionmentioning

confidence: 99%

“…Currently in daily clinical practice, substantial restraint remains in providing EVT to patients with mild deficits, particularly patients who are eligible for IVT . However, typical symptoms of infarcts in the territory of the PCA, such as hemianopia, may be associated with substantial restrictions in quality of life . The NIHSS score is weighted toward anterior circulation deficits and does not represent the entire spectrum of posterior circulation stroke symptoms that substantially lower NIHSS cutoff values for estimating long-term outcomes compared with the anterior circulation .…”

Section: Discussionmentioning

confidence: 99%

“…Because of the variability of vascular anatomy, isolated posterior circulation DMVO may be associated with wide-ranging neuropsychological symptoms that lead to delayed hospital admission and subsequent ineligibility for thrombolytic therapy options, especially in patients presenting with minor deficits . However, because of the vascular supply of eloquent brain areas (eg, the primary visual cortex and the thalami), stroke caused by posterior circulation DMVO can lead to acute, severe, and permanent disability with substantial impact on quality of life …”

Section: Introductionmentioning

confidence: 99%

“…7 However, because of the vascular supply of eloquent brain areas (eg, the primary visual cortex and the thalami), stroke caused by posterior circulation DMVO can lead to acute, severe, and permanent disability with substantial impact on quality of life. 6,8,9 In the absence of clear, guideline-based treatment recommendations for posterior circulation DMVO stroke, [10][11][12] a multiinstitutional, international consensus statement was recently published that highlights the clinical relevance and urgent need for evidence of the potential benefit of mechanical thrombectomy in this subgroup of patients. 13 This international, retrospective multicenter case-control study aimed to investigate the frequency as well as clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke of the PCA P2 and P3 segments and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice.…”

mentioning

confidence: 99%

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Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

et al. 2021

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IMPORTANCE Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse.OBJECTIVE To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. DESIGN, SETTING, AND PARTICIPANTSThis multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. INTERVENTIONS Mechanical thrombectomy or standard medical treatment with or without IVT.MAIN OUTCOMES AND MEASURES Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. RESULTSOf 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was −2.4 points (95% CI, −3.2 to −1.6) in the standard medical treatment cohort and −3.9 points (95% CI, −5.4 to −2.5) in the mechanical thrombectomy cohort, with a mean difference of −1.5 points (95% CI, 3.2 to −0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, −5.6; 95% CI, −10.9 to −0.2; P = .04) and in the subgroup of patients without IVT (mean difference, −3.0; 95% CI, −5.0 to −0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort.CONCLUSIONS AND RELEVANCE This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

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