Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke.

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

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 26

Pages Range: 290-299

Journal Issue: 2

DOI: 10.5853/jos.2024.00458

Abstract

BACKGROUND AND PURPOSE: Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. METHODS: From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0-1) and independent outcome (mRS 0-2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. RESULTS: Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3-P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79-1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05-2.12), sICH (aOR 2.87, 95% CI 1.23-6.72), and mortality (aOR 1.77, 95% CI 1.07-2.95). CONCLUSION: Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.

Authors with CRIS profile

Involved external institutions

Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Boston Medical Center (BMC) United States (USA) (US) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Universitätsklinikum Heidelberg Germany (DE) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Essen Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Rhode Island Hospital United States (USA) (US) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Inselspital, Universitätsspital Bern Switzerland (CH) Grady Memorial Hospital United States (USA) (US) Central Lisbon University Hospital Centre / Centro Hospitalar Universitário de Lisboa Central (CHULC) Portugal (PT) Ospedale “M. Bufalini” di Cesena Italy (IT) University of Science and Technology of China (USTC) China (CN) Mount Sinai Hospital United States (USA) (US) University of Texas Health Science Center at Houston (UTHealth Houston) United States (USA) (US) Hospital de Egas Moniz Portugal (PT) Hertie-Institut für klinische Hirnforschung 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) University of South Florida (USF) United States (USA) (US) Turku University Hospital / Turun yliopistollinen keskussairaala (TYKS) Finland (FI) Baptist Health South Florida United States (USA) (US) University of Miami United States (USA) (US) Berliner Institut für Gesundheitsforschung in der Charité / Berlin Institute of Health at Charité (BIH) Germany (DE) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) University of Chicago United States (USA) (US)

How to cite

APA:

Räty, S., Nguyen, T.N., Nagel, S., Strambo, D., Michel, P., Herweh, C.,... Strbian, D. (2024). Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke. Journal of Stroke, 26(2), 290-299. https://doi.org/10.5853/jos.2024.00458

MLA:

Räty, Silja, et al. "Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke." Journal of Stroke 26.2 (2024): 290-299.

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