Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion

Abdelnaby, Ramy; Mohamed, Khaled Ashraf; Elgenidy, Anas; Sonbol, Yousef Tarek; Bedewy, Mahmoud Mostafa; Aboutaleb, Aya Moustafa; Dardeer, Khaled Tarek; Heikal, Hamed Amr; Gawish, Hazem Maher; Nikoubashman, Omid; Reich, Arno; Pinho, João

doi:10.1007/s00062-022-01221-7

Cited by 4 publications

(1 citation statement)

References 28 publications

(48 reference statements)

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“…19 The rate of successful recanalization following EVT in our cohort was similar than reported by others on similar populations (74% versus 79% in a recent meta-analysis). 20 This relatively low rate of post-EVT successful recanalization may partly explain the lack of association between EVT and favorable outcomes in our study. Although the vast majority (94%) of EVT have been performed since 2015, rapid technical innovations have resulted in safer and more effective procedures in most recent years.…”

Section: Discussionmentioning

confidence: 52%

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Sabben

Charbonneau

Delvoye

et al. 2023

Stroke

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Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery (PCA) occlusion is unknown. Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6hrs from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the PCA and treated either with BMM + EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin score [mRS] 0-2 or return to baseline mRS). Secondary outcomes were 3-month excellent recovery (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and early neurological deterioration. Results: Overall, 752 patients were included (167 and 585 patients in the BMM + EVT and BMM alone groups, respectively). Median age was 74 (IQR 63-82) years, 329 (44%) patients were female, median NIHSS was 6 (IQR 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the two groups following propensity-score weighting. EVT was associated with a trend towards lower odds of good functional outcome (OR=0.81; 95%CI: 0.66-1.01; P=0.06) and was not associated with excellent functional outcome (OR=1.17; 95%CI: 0.95-1.43; P=0.15). EVT was associated with a higher risk of sICH (OR=2.51; 95%CI: 1.35-4.67; P=0.004) and early neurological deterioration (OR=2.51; 95%CI: 1.64-3.84; P<0.0001). Conclusions: In this observational study of patients with proximal PCA occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of sICH and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.

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Section: Discussionmentioning

confidence: 52%

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Sabben

Charbonneau

Delvoye

et al. 2023

Stroke

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Is Thrombectomy Worth It for Isolated Posterior Cerebral Artery Occlusion? Meta‐Analysis and Trial Sequential Analysis

Jhou,

Lee,

Tsai

et al. 2024

SVIN

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BACKGROUND Thrombectomy is well‐established management for acute ischemic stroke involving large vessel occlusion. However. the potential efficacy of thrombectomy for isolated posterior cerebral artery occlusion remains limited. The study aims to evaluate the benefits of thrombectomy for isolated posterior cerebral artery occlusion. METHODS We searched PubMed, Cochrane, and Embase for articles published until September 2023. The primary outcome was good functional outcome at 3 months. The secondary outcomes included excellent functional outcome at 3 months and early neurological improvement. The safety outcomes were symptomatic intracerebral hemorrhage, and mortality at 3 months. RESULTS Seven retrospective studies involving 2560 patients with isolated posterior cerebral artery occlusion were included (876 patients receiving thrombectomy). The odds ratio (OR) of good functional outcome at 3 months was 0.93 (95% CI, 0.68–1.28) between 2 groups. The OR of excellent functional outcome (OR 1.23; 95% CI 0.92–1.64) and early neurological improvement (OR 1.82; 95% CI 0.97–3.40) were not different between the 2 groups. Compared with patients with best medical management, those with thrombectomy demonstrated a significantly increased risk of mortality (OR 1.81; 95% CI 1.24–2.65), whereas the risk of symptomatic intracerebral hemorrhage (OR 2.033; 95% CI 0.996–4.148) did not show an increase. Additionally, the results of trial sequential analysis indicated all outcomes were inconclusive. CONCLUSION Thrombectomy stands as an available procedure for patients with isolated posterior cerebral artery occlusion; however, it shows no notable benefits in reducing symptomatic intracerebral hemorrhage risk or enhancing function and may raise mortality compared with standard medical management. Further randomized controlled trials are necessary to yield more conclusive evidence.

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Endovascular thrombectomy for posterior cerebral artery strokes in the national inpatient sample (EaT PeCANpIeS) study

Brake,

Fry,

Heskett

et al. 2024

Interv Neuroradiol

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Background Posterior cerebral arteries with acute ischemic strokes (PCA-AISs) comprise around 2% of all acute ischemic strokes and may result in significant long-term deficits. Current guidance regarding endovascular thrombectomy (EVT) for PCA-AIS is insufficient as no published randomized trials exist. Methods An analysis of the National Inpatient Sample database compared medical management versus EVT for PCA-AIS. Propensity score matching was applied to adjust for nonrandomization. Results The study included 19,655 patients. Before matching, the EVT cohort had significantly higher National Institutes of Health Stroke Scale (NIHSS) (10.21 vs. 4.67, p < 0.001), had lower rates of favorable functional outcomes, functional independence, and higher rates of intracranial hemorrhage (ICH) and inpatient mortality. After matching, no differences in functional outcomes were identified, but revealed a higher proportion of ICH in the EVT group (17.45% vs. 8.98%, p < 0.001). However, NIHSS subgroup analysis identified improved functional outcomes associated with the EVT group who presented with an NIHSS between 10 and 19 both in terms of rates of favorable functional outcomes (35.56% vs. 12.09%, p < 0.001) and rates of functional independence (26.67% vs. 9.34%, p < 0.01). On further investigation, the clinical benefit, in the NIHSS 10-19 subgroup, was driven by patients receiving EVT in combination with intravenous thrombolysis (IVT). Conclusions This analysis shows that current national practices utilize EVT for more severe PCA strokes. Clinical benefit was only detected in patients with moderate stroke severity (NIHSS 10-19) who were treated with combined EVT and IVT. Further work is needed to investigate the features of PCA-AIS that might benefit from EVT the most.

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Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion

Cited by 4 publications

References 28 publications

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Is Thrombectomy Worth It for Isolated Posterior Cerebral Artery Occlusion? Meta‐Analysis and Trial Sequential Analysis

Endovascular thrombectomy for posterior cerebral artery strokes in the national inpatient sample (EaT PeCANpIeS) study

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