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

Details

Serval ID
serval:BIB_B0A694006B36
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke.
Journal
Journal of stroke
Author(s)
Räty S., Nguyen T.N., Nagel S., Strambo D., Michel P., Herweh C., Qureshi M.M., Abdalkader M., Virtanen P., Olive-Gadea M., Ribo M., Psychogios M., Nguyen A., Kuramatsu J.B., Haupenthal D., Köhrmann M., Deuschl C., Escolà J.K., Demeestere J., Lemmens R., Vandewalle L., Yaghi S., Shu L., Puetz V., Kaiser DPO, Kaesmacher J., Mujanovic A., Marterstoc D.C., Engelhorn T., Berberich A., Klein P., Haussen D.C., Mohammaden M.H., Abdelhamid H., Fragata I., Cunha B., Romoli M., Hu W., Song J., Fifi J.T., Matsoukas S., Sheth S.A., Salazar-Marioni S.A., Marto J.P., Ramos J.N., Miszczuk M., Riegler C., Poli S., Poli K., Jadhav A.P., Desai S., Maus V., Kaeder M., Siddiqui A.H., Monteiro A., Kokkonen T., Diana F., Masoud H.E., Suryadareva N., Mokin M., Thanki S., Ylikotila P., Alpay K., Siegler J.E., Linfante I., Dabus G., Yavaghal D., Saini V., Nolte C.H., Siebert E., Möhlenbruch M.A., Ringleb P.A., Nogueira R.G., Hanning U., Meyer L., Fischer U., Strbian D.
ISSN
2287-6391 (Print)
ISSN-L
2287-6391
Publication state
Published
Issued date
05/2024
Peer-reviewed
Oui
Volume
26
Number
2
Pages
290-299
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
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.
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).
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.
Keywords
Endovascular thrombectomy, Intravenous thrombolysis, Posterior cerebral artery, Posterior circulation stroke
Pubmed
Open Access
Yes
Create date
14/06/2024 11:08
Last modification date
15/06/2024 7:04
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