Journal of Stroke (May 2024)
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 Olive-Gadea,
- Marc Ribo,
- Marios Psychogios,
- Anh Nguyen,
- 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 P.O. Kaiser,
- Johannes Kaesmacher,
- Adnan Mujanovic,
- Dominique Cornelius Marterstoc,
- Tobias Engelhorn,
- Anne Berberich,
- Piers Klein,
- Diogo C. Haussen,
- Mahmoud H. Mohammaden,
- Hend Abdelhamid,
- Isabel Fragata,
- Bruno Cunha,
- Michele Romoli,
- Wei Hu,
- Jianlon Song,
- Johanna T. Fifi,
- Stavros Matsoukas,
- Sunil A. Sheth,
- Sergio A. 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,
- Andre Monteiro,
- Tatu Kokkonen,
- Francesco Diana,
- Hesham E. 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 A. Möhlenbruch,
- Peter A. Ringleb,
- Raul G. Nogueira,
- Uta Hanning,
- Lukas Meyer,
- Urs Fischer,
- Daniel Strbian
Affiliations
- Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Thanh N. Nguyen
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Davide Strambo
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Patrik Michel
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Christian Herweh
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Muhammad M. Qureshi
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Pekka Virtanen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Marta Olive-Gadea
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
- Marc Ribo
- Department of Neurology, University Hospital Vall d’Hebron, Barcelona, Spain
- Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Anh Nguyen
- Department of Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Joji B. Kuramatsu
- Department of Neurology, University of Erlangen, Erlangen, Germany
- David Haupenthal
- Department of Neurology, University of Erlangen, Erlangen, Germany
- Martin Köhrmann
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
- Cornelius Deuschl
- Department of Radiology, Universitätsklinikum Essen, Essen, Germany
- Jordi Kühne Escolà
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
- Jelle Demeestere
- Department of Neurology, UZ Leuven, Leuven, Belgium
- Robin Lemmens
- Department of Neurology, UZ Leuven, Leuven, Belgium
- Lieselotte Vandewalle
- Department of Neurology, UZ Leuven, Leuven, Belgium
- Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA
- Liqi Shu
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA
- Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Daniel P.O. Kaiser
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
- Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
- Dominique Cornelius Marterstoc
- Department of Neuroradiology, University of Erlangen, Erlangen, Germany
- Tobias Engelhorn
- Department of Neuroradiology, University of Erlangen, Erlangen, Germany
- Anne Berberich
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Piers Klein
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Diogo C. Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
- Mahmoud H. Mohammaden
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
- Hend Abdelhamid
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
- Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
- Bruno Cunha
- Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
- Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
- Wei Hu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Jianlon Song
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Johanna T. Fifi
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
- Stavros Matsoukas
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
- Sunil A. Sheth
- Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA
- Sergio A. Salazar-Marioni
- Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA
- João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Milena Miszczuk
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Christoph Riegler
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Sven Poli
- Hertie-Institute for Clinical Brain Research, Tübingen University, Tübingen, Germany
- Khouloud Poli
- Hertie-Institute for Clinical Brain Research, Tübingen University, Tübingen, Germany
- Ashutosh P. Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
- Shashvat Desai
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
- Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Maximilian Kaeder
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Adnan H. Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA
- Andre Monteiro
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA
- Tatu Kokkonen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Francesco Diana
- Department of Interventional Neuroradiology, University Hospital Vall d’Hebron, Barcelona, Spain
- Hesham E. Masoud
- Department of Neurology, New York Upstate Medical University, Syracuse, NY, USA
- Neil Suryadareva
- Department of Neurology, New York Upstate Medical University, Syracuse, NY, USA
- Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
- Shail Thanki
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
- Pauli Ylikotila
- Department of Neurology, Turku University Hospital and University of Turku, Turku, Finland
- Kemal Alpay
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
- James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
- Italo Linfante
- Miami Neuroscience Institute, Miami, FL, USA
- Guilherme Dabus
- Miami Neuroscience Institute, Miami, FL, USA
- Dileep Yavaghal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Vasu Saini
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Christian H. Nolte
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Eberhart Siebert
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Markus A. Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Urs Fischer
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
- Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- DOI
- https://doi.org/10.5853/jos.2024.00458
- Journal volume & issue
-
Vol. 26,
no. 2
pp. 290 – 299
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.
Keywords
- endovascular thrombectomy
- intravenous thrombolysis
- posterior cerebral artery
- posterior circulation stroke
