J Stroke.  2024 May;26(2):290-299. 10.5853/jos.2024.00458.

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 JB
• 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

• KMID: 2556049
• DOI: http://doi.org/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.

Keyword

Endovascular thrombectomy; Intravenous thrombolysis; Posterior cerebral artery; Posterior circulation stroke

Figure

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  Figure 1. Flowchart of the study cohort. PCA, posterior cerebral artery; IVT, intravenous thrombolysis; EVT, endovascular thrombectomy; mRS, modified Rankin Scale; pc-ASPECTS, posterior circulation Acute Stroke Prognosis Early CT Score; ENI, early neurological improvement; sICH, symptomatic intracranial hemorrhage.

• 

  Figure 2. Distribution of the 3-month modified Rankin Scale (mRS) in patients with isolated posterior cerebral artery occlusion by endovascular therapy (EVT) with or without intravenous thrombolysis (IVT) versus IVT alone.

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