Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study.

Nguyen TN, Qureshi MM, Strambo D, Strbian D, Räty S, Herweh C, Abdalkader M, Olive-Gadea M, Ribo M, Psychogios M, Fischer U, Nguyen A, Kuramatsu J, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escola J, Yaghi S, Shu L, Puetz V, Kaiser DP, Kaesmacher J, Mujanovic A, Marterstock D, Engelhorn T, Klein P, Haussen DC, Mohammaden MH, Abdelhamid H, Souza Viana L, Cunha B, Fragata I, Romoli M, Diana F, Virtanen P, Lappalainen K, Clark J, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni S, Marto JP, Ramos JN, Miszczuk M, Riegler C, Jadhav AP, Desai SM, Maus V, Kaeder M, Siddiqui AH, Monteiro A, Masoud HE, Suryadevara N, Mokin M, Thanki S, Siegler JE, Khalife J, Linfante I, Dabus G, Asdaghi N, Saini V, Nolte CH, Siebert E, Meinel TR, Finitsis S, Möhlenbruch MA, Ringleb PA, Berberich A, Nogueira RG, Hanning U, Meyer L, Michel P, Nagel S (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 54

Pages Range: 1708-1717

Journal Issue: 7

DOI: 10.1161/STROKEAHA.123.042674

Abstract

BACKGROUND: The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. METHODS: This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale. RESULTS: Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). CONCLUSIONS: In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Heidelberg Germany (DE) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Baptist Health South Florida United States (USA) (US) University of Miami United States (USA) (US) Freie Universität Berlin Germany (DE) Boston Medical Center (BMC) United States (USA) (US) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Essen Germany (DE) Brown University United States (USA) (US) Inselspital, Universitätsspital Bern Switzerland (CH) Grady Memorial Hospital United States (USA) (US) Centro Hospitalar de Lisboa Central Portugal (PT) Ospedale “M. Bufalini” di Cesena Italy (IT) Icahn School of Medicine at Mount Sinai United States (USA) (US) University of Texas Health Science Center at Houston (UTHealth) United States (USA) (US) Hospital de Egas Moniz Portugal (PT) Barrow Neurological Institute United States (USA) (US) Universitätsklinikum Knappschaftskrankenhaus Bochum Germany (DE) University at Buffalo. State University of New York United States (USA) (US) SUNY Upstate Medical University United States (USA) (US) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) University of South Florida (USF) United States (USA) (US) Cooper University Hospital United States (USA) (US) Aristotle University of Thessaloniki Greece (GR) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE)

How to cite

APA:

Nguyen, T.N., Qureshi, M.M., Strambo, D., Strbian, D., Räty, S., Herweh, C.,... Nagel, S. (2023). Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. Stroke, 54(7), 1708-1717. https://dx.doi.org/10.1161/STROKEAHA.123.042674

MLA:

Nguyen, Thanh N., et al. "Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study." Stroke 54.7 (2023): 1708-1717.

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