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

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

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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