Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site

Strambo D, Michel P, Nguyen TN, Abdalkader M, Qureshi MM, Strbian D, Herweh C, Möhlenbruch MA, Räty S, Olivé-Gadea M, Ribo M, Psychogios M, Fischer U, Nguyen A, Kuramatsu J, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escolà J, Demeestere J, Lemmens R, Vandewalle L, Yaghi S, Shu L, Puetz V, Kaiser DP, Kaesmacher J, Mujanovic A, Marterstock D, Engelhorn TM, Requena M, Dasenbrock HH, Klein P, Haussen DC, Mohammaden MH, Abdelhamid H, Souza Viana L, Cunha B, Fragata I, Romoli M, Diana F, Hu W, Zhang C, Virtanen P, Lauha R, Jesser J, Clark J, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni S, Marto JP, Ramos JN, Miszczuk M, Riegler C, Poli S, Poli K, Jadhav AP, Desai SM, Maus V, Kaeder M, Siddiqui AH, Monteiro A, Masoud HE, Suryadareva N, Mokin M, Thanki S, Alpay K, Ylikotila P, Siegler JE, Linfante I, Dabus G, Asdaghi N, Saini V, Nolte CH, Siebert E, Serrallach BL, Weyland CS, Hanning U, Meyer L, Berberich A, Ringleb PA, Nogueira RG, Nagel S (2024)

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 55

Pages Range: 1787-1797

Journal Issue: 7

DOI: 10.1161/STROKEAHA.124.047383

Abstract

BACKGROUND: Acute ischemic stroke with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO acute ischemic stroke is modified by initial stroke severity (baseline National Institutes of Health Stroke Scale [NIHSS]) and arterial occlusion site. METHODS: Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0-1), functional independence (mRS score 0-2), symptomatic intracranial hemorrhage, and mortality. RESULTS: From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution (Pinteraction=0.312) but did with functional independence (Pinteraction=0.010), with a similar trend on excellent outcome (Pinteraction=0.069). EVT was associated with more favorable outcomes than MM in patients with baseline NIHSS score >6 (mRS score 0-1, 30.6% versus 17.7%; adjusted odds ratio [aOR], 2.01 [95% CI, 1.22-3.31]; mRS score 0 to 2, 46.1% versus 31.9%; aOR, 1.64 [95% CI, 1.08-2.51]) but not in those with NIHSS score ≤6 (mRS score 0-1, 43.8% versus 46.3%; aOR, 0.90 [95% CI, 0.49-1.64]; mRS score 0-2, 65.3% versus 74.3%; aOR, 0.55 [95% CI, 0.30-1.0]). EVT was associated with more symptomatic intracranial hemorrhage regardless of baseline NIHSS score (Pinteraction=0.467), while the mortality increase was more pronounced in patients with NIHSS score ≤6 (Pinteraction=0.044; NIHSS score ≤6: aOR, 7.95 [95% CI, 3.11-20.28]; NIHSS score >6: aOR, 1.98 [95% CI, 1.08-3.65]). Arterial occlusion site did not modify the association of EVT with outcomes compared with MM. CONCLUSIONS: Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.

Authors with CRIS profile

Involved external institutions

Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Boston Medical Center (BMC) United States (USA) (US) Universitätsklinikum Heidelberg Germany (DE) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Essen Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) Barrow Neurological Institute United States (USA) (US) Universitätsklinikum Knappschaftskrankenhaus Bochum Germany (DE) University at Buffalo. State University of New York (SUNY Buffalo) United States (USA) (US) State University of New York Upstate Medical University (SUNY) United States (USA) (US) Turku University Hospital / Turun yliopistollinen keskussairaala (TYKS) Finland (FI) University of Chicago United States (USA) (US) Baptist Health South Florida United States (USA) (US) University of Miami United States (USA) (US) Charité - Universitätsmedizin Berlin Germany (DE) Inselspital, Universitätsspital Bern Switzerland (CH) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Rhode Island Hospital United States (USA) (US) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Grady Memorial Hospital United States (USA) (US) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) University of South Florida (USF) United States (USA) (US) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) McGovern Medical School United States (USA) (US) Hospital de Egas Moniz Portugal (PT) Centro Hospitalar de Lisboa Central Portugal (PT) Ospedale “M. Bufalini” di Cesena Italy (IT) Mount Sinai Health System United States (USA) (US) Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona Italy (IT)

How to cite

APA:

Strambo, D., Michel, P., Nguyen, T.N., Abdalkader, M., Qureshi, M.M., Strbian, D.,... Nagel, S. (2024). Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site. Stroke, 55(7), 1787-1797. https://doi.org/10.1161/STROKEAHA.124.047383

MLA:

Strambo, Davide, et al. "Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site." Stroke 55.7 (2024): 1787-1797.

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