Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke
Silja Räty, Thanh N. Nguyen, Simon Nagel, Davide Strambo, Patrik Michel, Christian Herweh, Muhammad M. Qureshi, Mohamad Abdalkader, Pekka Virtanen, Marta Olivé‐Gadea, Marc Ribó, Marios Psychogios, Anh Nguyên, Joji B. Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escolà, Jelle Demeestere, Robin Lemmens, Lieselotte Vandewalle, Shadi Yaghi, Liqi Shu, Volker Puetz, Daniel Kaiser, Johannes Kaesmacher, Adnan Mujanović, Dominique Cornelius Marterstoc, Tobias Engelhorn, Anne Berberich, Piers Klein, Diogo C Haussen, Mahmoud Mohammaden, Hend Abdelhamid, Isabel Fragata, Bruno Cunha, Michele Romoli, Wei Hu, Jianlon Song, Johanna T Fifi, Stavros Matsoukas, Sunil A. Sheth, Sergio Salazar‐Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Sven Poli, Khouloud Poli, Ashutosh P. Jadhav, Shashvat Desai, Volker Maus, Maximilian Kaeder, Adnan H. Siddiqui, André Monteiro, Tatu Kokkonen, Francesco Diana, Hesham Masoud, Neil Suryadareva, Maxim Mokin, Shail Thanki, Pauli Ylikotila, Kemal Alpay, James E. Siegler, Italo Linfante, Guilherme Dabus, Dileep Yavaghal, Vasu Saini, Christian H. Nolte, Eberhart Siebert, Markus Möhlenbruch, Peter A. Ringleb, Raul G. Nogueira, Uta Hanning, Lukas Meyer, Urs Fischer, Daniel Strbian
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.