A1 Refereed original research article in a scientific journal
Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke
Authors: Räty, Silja; Nguyen, Thanh N; Nagel, Simon; Strambo, Davide; Michel, Patrik; Herweh, Christian; Qureshi, Muhammad M; Abdalkader, Mohamad; Virtanen, Pekka; Olive-Gadea, Marta; Ribo, Marc; Psychogios, Marios; Nguyen, Anh; Kuramatsu, Joji B; Haupenthal, David; Köhrmann, Martin; Deuschl, Cornelius; Kühne Escolà, Jordi; Demeestere, Jelle; Lemmens, Robin; Vandewalle, Lieselotte; Yaghi, Shadi; Shu, Liqi; Puetz, Volker; Kaiser, Daniel P O; Kaesmacher, Johannes; Mujanovic, Adnan; Marterstoc, Dominique Cornelius; Engelhorn, Tobias; Berberich, Anne; Klein, Piers; Haussen, Diogo C; Mohammaden, Mahmoud H; Abdelhamid, Hend; Fragata, Isabel; Cunha, Bruno; Romoli, Michele; Hu, Wei; Song, Jianlon; Fifi, Johanna T; Matsoukas, Stavros; Sheth, Sunil A; Salazar-Marioni, Sergio A; Marto, João Pedro; Ramos, João Nuno; Miszczuk, Milena; Riegler, Christoph; Poli, Sven; Poli, Khouloud; Jadhav, Ashutosh P; Desai, Shashvat; Maus, Volker; Kaeder, Maximilian; Siddiqui, Adnan H; Monteiro, Andre; Kokkonen, Tatu; Diana, Francesco; Masoud, Hesham E; Suryadareva, Neil; Mokin, Maxim; Thanki, Shail; Ylikotila, Pauli; Alpay, Kemal; Siegler, James E; Linfante, Italo; Dabus, Guilherme; Yavaghal, Dileep; Saini, Vasu; Nolte, Christian H; Siebert, Eberhart; Möhlenbruch, Markus A; Ringleb, Peter A; Nogueira, Raul G; Hanning, Uta; Meyer, Lukas; Fischer, Urs; Strbian, Daniel
Publisher: Korean Stroke Society
Publication year: 2024
Journal: Journal of Stroke
Journal name in source: Journal of stroke
Journal acronym: J Stroke
Volume: 26
Issue: 2
First page : 290
Last page: 299
ISSN: 2287-6391
DOI: https://doi.org/10.5853/jos.2024.00458
Web address : https://j-stroke.org/journal/view.php?doi=10.5853/jos.2024.00458
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/454760140
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.
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Funding statement: None
