Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery

Herweh, Christian; Abdalkader, Mohamad; Nguyen, Thanh N.; Puetz, Volker; Schöne, Daniela; Kaiser, Daniel; Chen, Chih‐Hao; Jeng, Jiann‐Shing; Möhlenbruch, Markus; Ringleb, Peter A.; Nagel, Simon

doi:10.3389/fneur.2021.697348

Cited by 36 publications

(55 citation statements)

References 16 publications

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“…Twelve studies were included in the analysis [5, 12–16, 18, 19, 21, 25, 26, 29]. The search strategy is shown in Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, EVT is increasingly used to treat patients with isolated occlusions of the PCA. Several recent studies demonstrated the feasibility and safety of EVT in these patients [5,[12][13][14][15][16][17][18][19][20][21]. However, randomized clinical trials demonstrating the efficacy of EVT in the treatment of isolated PCA occlusions are lacking.…”

Section: Although Clinical Symptoms Of Pca Infarcts May Results In a Lowmentioning

confidence: 99%

“…Complete reperfusion was achieved more frequently in patients treated with EVT + BMM, with rates of complete reperfusion ranging from 58.8% to 100% in the respective studies compared with recanalization rates of 43.6%–66.6% observed in patients treated with BMM alone, although this was not angiographically proven for the latter group in most of the cases. Meyer et al and Herweh et al reported that successful recanalization more often resulted in early neurological improvement, although this was not reflected in improvement of mRS score at 3 months [12, 13].…”

Section: Discussionmentioning

confidence: 99%

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Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis

Berberich

Finitsis

Strambo

et al. 2022

Euro J of Neurology

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Background and purpose Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study‐level meta‐analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0–2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results Twelve studies with a total of 679 patients were included in the meta‐analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83–70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35–55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30–20.93) and 12.3% (95% CI 8.64–17.33). sICH occurred in 4.2% (95% CI 2.47–7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75–5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.

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“…Twelve studies were included in the analysis [5, 12–16, 18, 19, 21, 25, 26, 29]. The search strategy is shown in Figure S1.…”

Section: Resultsmentioning

confidence: 99%

Section: Although Clinical Symptoms Of Pca Infarcts May Results In a Lowmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis

Berberich

Finitsis

Strambo

et al. 2022

Euro J of Neurology

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“…Good outcomes were observed in 59‒66% of all patients at 90 days after EVT ( 16 – 18 ). Memon et al ( 16 ) and Herweh et al ( 19 ) presented the results of studies of 15 and 23 patients with isolated PPCA occlusion, respectively, who were treated with EVT. The successful recanalization rates were 80% and 54%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Acute Ischemic Stroke Due to Isolated Proximal Posterior Artery Occlusion

et al. 2022

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BackgroundAcute ischemic stroke (AIS) due to isolated proximal posterior cerebral artery (PPCA) occlusion is rare but associated with high morbidity and mortality rates. However, the optimal treatment strategy for patients with AIS caused by PPCA remains unclear. We discuss our single-center experience with endovascular treatment (EVT) in patients with PPCA.MethodsData from patients with AIS due to PPCA occlusion were retrospectively analyzed. We analyzed procedural details, the degree of reperfusion, functional outcomes, and complications. Functional outcomes were determined using the modified Rankin Scale (mRS) at 90 days, and good outcome was defined as mRS 0–2 at 90 days. Successful reperfusion was defined as modified treatment in cerebral ischemia (mTICI) 2b−3 after endovascular therapy. Safety variables included symptomatic hemorrhage (defined as an increase of four or more points in the National Institute of Health Stroke Scale score), vessel perforation or dissection, and new ischemic stroke in different territories.ResultsSeven patients were included in this study. The mean age of the patients was 64 ± 12.4 years. Successful reperfusion was achieved in all seven patients (100%). Good outcomes were achieved at 90 days in 2 patients (28.6%), and favorable outcomes were observed in five patients (71.4%). One patient underwent angioplasty as rescue therapy after three attempts. One patient died because of severe gastrointestinal bleeding 24 h after EVT, which was probably a complication of intravenous alteplase. One patient had an embolism in the basilar artery and achieved complete reperfusion after rescue thrombectomy. Another patient had a complication of vessel dissection in the PPCA and underwent stent implantation as rescue therapy. We observed no recurrence of ischemic stroke or any intracranial hemorrhage on non-contrast computed tomography 24 h after the procedure.ConclusionEVT may represent an alternative treatment strategy for patients with acute ischemic stroke caused by PPCA.

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“…Mechanical thrombectomy is safe and effective and should be considered in patients presenting with isolated hemianopsia due to acute posterior cerebral artery occlusion. 5 Although the small diameter of the central retinal artery precludes mechanical thrombectomy in patients with CRAO, treatment with intra-arterial tPA may be a consideration if patients with CRAO are not eligible or have contraindications for IV tPA and present in specialized centers within 6 hours of visual loss. 4…”

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confidence: 99%

Improving the Telemedicine Evaluation of Patients With Acute Vision Loss

et al. 2022

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Acute vision loss related to cerebral or retinal ischemia is a time-sensitive emergency with potential treatment options including intravenous or intraarterial thrombolysis and mechanical thrombectomy. However, patients either present in delayed fashion or present to an emergency department that lacks the subspecialty expertise to recognize and treat these conditions in a timely fashion. Moreover, healthcare systems in the United States are becoming increasingly reliant on telestroke and teleneurology services for acute neurologic care, making accurate diagnosis of acute vision loss even more challenging due to critical limitations to the remote video evaluation, including the inability to perform routine ophthalmoscopy. The COVID-19 pandemic has led to a greater reliance on telemedicine services and helped to accelerate the development of novel tools and care pathways to improve remote ophthalmologic evaluation, but these tools have yet to be adapted for use in the remote evaluation of acute vision loss. Permanent vision loss can be disabling for patients and efforts must be made to increase and improve early diagnosis and management. Herein, the authors outline the importance of improving acute ophthalmologic diagnosis, outline key limitations and barriers to the current video-based teleneurology assessments, highlight opportunities to leverage new tools to enhance the remote assessment of vision loss, and propose new avenues to improve access to emergent ophthalmology subspeciality.

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Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery

Cited by 36 publications

References 16 publications

Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis

Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis

Endovascular Treatment of Acute Ischemic Stroke Due to Isolated Proximal Posterior Artery Occlusion

Improving the Telemedicine Evaluation of Patients With Acute Vision Loss

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