Efficacy and safety of endovascular therapy for acute stroke due to posterior circulation large vessel occlusion: a real-world multicenter retrospective study

Abstract

Objective To evaluate the efficacy and safety of endovascular treatment for acute ischemic stroke caused by large vessel occlusion of posterior circulation in the real world. Methods The baseline and clinical data of stroke patients with posterior circulation occlusion who received emergency endovascular treatment (EVT) at 9 stroke centers in the Southwest China from January 2018 to August 2020 were collected and retrospectively analyzed. The main observation indicators included modified Rankin Scale (mRS) score at 90 d, postoperative modified Thrombolysis in Cerebral Infarction (mTICI) score, symptomatic intracranial hemorrhage (sICH), etc. The enrolled patients were divided into good prognosis group (mRS ≤2) and poor prognosis group (mRS >2) according to their mRS score in 90 d postoperatively. Student's t test and Chi-square analysis were employed to compare the differences in baseline and clinical data between the 2 groups, and the results were further analyzed in subgroups. Results A total of 108 patients were enrolled in this study. In 90 d after treatment, the ratio of good prognosis was 43.5% (47/108), mortality rate 25.9% (28/108), vessel recanalization rate 95.4% (103/108), and sICH rate 8.3% (9/108). There were significant differences between the 2 groups in preoperative Posterior circulation Alberta Stroke Program Early CT Score (Pc-ASPECTS), National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, vessel recanalization rate and sICH rate (P < 0.05). The results of subgroup analysis suggested that the patients with a shorter recanalization time had a higher rate of good prognosis (P < 0.05), and those with good recanalization had lower mortality rate (P < 0.05). Conclusion In the real world, endovascular treatment for large-vessel occlusive stroke in the posterior circulation is safe and effective. Rapid recanalization of occlusive vessels is beneficial to improve the clinical prognosis and reduce mortality.

Keywords

• acute ischemic stroke
• posterior circulation
• endovascular treatment
• real-world study