Outcomes and Complications of Endovascular Mechanical Thrombectomy in the Treatment of Acute Posterior Circulation Occlusions: A Systematic Review

Watson, Carlton; Feria, Alejandro; Chen, Ching-Jen; Camacho, Arturo

doi:10.1016/j.wneu.2020.08.221

Cited by 17 publications

(20 citation statements)

References 33 publications

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“… 19 We did not find such associations in our analysis, but no separate analysis for aspiration first and stent retriever thrombectomy were done. In two systematic reviews, aspiration as first attempt appeared to be superior to stent retriever in achieving modified treatment in cerebral infarction (mTICI) 2b-3 in patients with PCS, 3 20 which is not in line with our results. However, in the ASTER trial where patients with an anterior circulation ischemic stroke were randomly assigned to EVT with a stent retriever or aspiration, similar rates of FPR were achieved in both groups.…”

Section: Discussioncontrasting

confidence: 75%

“…Variables associated with outcome and reperfusion in patients with PCS are heterogeneous. 3 It has been suggested that patients with PCS may have a different underlying pathophysiology than patients with anterior circulation ischemic stroke, which secondarily influences reperfusion and outcomes. 3 Previous studies showed that in patients with a basilar artery occlusion, successful reperfusion is a strong predictor of favorable 90-day outcome.…”

Section: Introductionmentioning

confidence: 99%

“… 3 It has been suggested that patients with PCS may have a different underlying pathophysiology than patients with anterior circulation ischemic stroke, which secondarily influences reperfusion and outcomes. 3 Previous studies showed that in patients with a basilar artery occlusion, successful reperfusion is a strong predictor of favorable 90-day outcome. 4–8 However, other studies showed more heterogeneity of clinical outcome despite high reperfusion rates.…”

Section: Introductionmentioning

confidence: 99%

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Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

Hartog

Roozenbeek

Boodt

et al. 2021

J NeuroIntervent Surg

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BackgroundFirst pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS.MethodsWe used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models.ResultsOf 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (−45% (95% CI: −65% to −12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: −14% (95% CI: −51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)).ConclusionsFPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.

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Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

Hartog

Roozenbeek

Boodt

et al. 2021

J NeuroIntervent Surg

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“…This compares favorably to a recent systematic review of posterior circulation LVO MT treatment which demonstrated 38% favorable outcomes at 90 days and 30% mortality. 22…”

Section: Discussionmentioning

confidence: 99%

“…This compares favorably to a recent systematic review of posterior circulation LVO MT treatment which demonstrated 38% favorable outcomes at 90 days and 30% mortality. 22 The high rate of successful revascularization achieved in COMPLETE's posterior circulation cohort (92.2% mTICI 2b-3 postprocedure and first pass mTICI 2b-3, 2c-3, and 3 of 72.5%, 60.8%, and 56.9%, respectively, versus 56.4%, 40.5%, and 30.6%, respectively, in the anterior circulation LVO with ASPECTS≥6 cohort) is an important finding that warrants further investigation.…”

Section: Additional Subgroup Outcomes In the Complete Real-world Regi...mentioning

confidence: 92%

Endovascular Treatment of Acute Ischemic Stroke With the Penumbra System in Routine Practice: COMPLETE Registry Results

Zaidat

Fifi

Nanda

et al. 2022

Stroke

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Background and Purpose: The purpose of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device) registry was to evaluate the generalizability of the safety and efficacy of the Penumbra System (Penumbra, Inc, Alameda) in a real-world setting. Methods: COMPLETE was a global, prospective, postmarket, multicenter registry. Patients with large vessel occlusion–acute ischemic stroke who underwent mechanical thrombectomy using the Penumbra System with or without the 3D Revascularization Device as frontline approach were enrolled at 42 centers (29 United States, 13 Europe) from July 2018 to October 2019. Primary efficacy end points were successful postprocedure angiographic revascularization (modified Thrombolysis in Cerebral Infarction ≥2b) and 90-day functional outcome (modified Rankin Scale score 0–2). The primary safety end point was 90-day all-cause mortality. An imaging core lab determined modified Thrombolysis in Cerebral Infarction scores, Alberta Stroke Program Early CT Scores, clot location, and occurrence of intracranial hemorrhage at 24 hours. Independent medical reviewers adjudicated safety end points. Results: Six hundred fifty patients were enrolled (median age 70 years, 54.0% female, 49.2% given intravenous recombinant tissue plasminogen activator before thrombectomy). Rate of modified Thrombolysis in Cerebral Infarction 2b to 3 postprocedure was 87.8% (95% CI, 85.3%–90.4%). First pass and postprocedure rates of modified Thrombolysis in Cerebral Infarction 2c to 3 were 41.5% and 66.2%, respectively. At 90 days, 55.8% (95% CI, 51.9%–59.7%) had modified Rankin Scale score 0 to 2, and all-cause mortality was 15.5% (95% CI, 12.8%–18.3%). Conclusions: Using Penumbra System for frontline mechanical thrombectomy treatment of patients with large vessel occlusion–acute ischemic stroke in a real-world setting was associated with angiographic, clinical, and safety outcomes that were comparable to prior randomized clinical trials with stringent site and operator selection criteria. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03464565.

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Triage of Stroke Patients for Urgent Intervention

Gomez

French

Siddiq

et al. 2022

Current Clinical Neurology

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Outcomes and Complications of Endovascular Mechanical Thrombectomy in the Treatment of Acute Posterior Circulation Occlusions: A Systematic Review

Cited by 17 publications

References 33 publications

Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

Endovascular Treatment of Acute Ischemic Stroke With the Penumbra System in Routine Practice: COMPLETE Registry Results

Triage of Stroke Patients for Urgent Intervention

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