Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study-Reference-Cited by-同舟云学术

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

Published:2023-04 Issue:4 Volume:54 Page:928-937
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Sabben Candice¹^ORCID,Charbonneau Frédérique²^ORCID,Delvoye François³^ORCID,Strambo Davide⁴^ORCID,Heldner Mirjam R.⁵^ORCID,Ong Elodie⁶,Ter Schiphorst Adrien⁷,Henon Hilde⁸^ORCID,Ben Hassen Wagih⁹^ORCID,Agasse-Lafont Thomas¹⁰^ORCID,Legris Loïc¹¹^ORCID,Sibon Igor¹²^ORCID,Wolff Valérie¹³,Sablot Denis¹⁴^ORCID,Elhorany Mahmoud¹⁵¹⁶^ORCID,Preterre Cécile¹⁷,Nehme Nour¹⁸,Soize Sébastien¹⁹^ORCID,Weisenburger-Lile David²⁰,Triquenot-Bagan Aude²¹^ORCID,Mione Gioia²²^ORCID,Aignatoaie Andreea²³,Papassin Jérémie²⁴,Poll Roxana²⁵,Béjot Yannick²⁶^ORCID,Carrera Emmanuel²⁷^ORCID,Garnier Pierre²⁸,Michel Patrik⁴^ORCID,Saliou Guillaume²⁹^ORCID,Mordasini Pasquale³⁰,Berthezene Yves³¹,Costalat Vincent³²,Bricout Nicolas³³^ORCID,Albers Gregory W.³⁴^ORCID,Mazighi Mikael³³⁵³⁶^ORCID,Turc Guillaume³⁶³⁷³⁸^ORCID,Seners Pierre¹³⁴^ORCID,Antonenko Kateryna,Arquizan Caroline,Benammar Lynda,Boutet Claire,Clarençon Frédéric,Comby Pierre-Olivier,Desal Hubert,Detante Olivier,Eugene François,Gerardin Emmanuel,Gory Benjamin,Kremer Stéphane,Ledure Sylvain,Krug Mathieu,Lapergue Bertrand,Niclot Philippe,Magni Christophe,Obadia Michael,Ozsancak Canan,Pico Fernando,Pilgram-Pastor Sara,Pop Raoul,Richard Sébastien,Rosso Charlotte,Savatovsky Julien,Moulin Solène,Tracol Clément,Zbinden Martin

Affiliation:

1. Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France.

2. Neuroradiology Department (F.C.), Rothschild Foundation Hospital, Paris, France.

3. Interventional Neuroradiology Department (F.D., M.M.), Rothschild Foundation Hospital, Paris, France.

4. Stroke Center, Neurology Service (D.S., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland.

5. Department of Neurology, University Hospital and University of Bern, Switzerland (M.R.H.).

6. Stroke Department, Hospices Civils de Lyon, France (E.O.).

7. Neurology Department, CHRU Gui de Chauliac, Montpellier, France (A.T.S.).

8. Neurology department, Stroke Center, University of Lille, Inserm U1171, CHU Lille, LilNCog - Lille Neuroscience & Cognition, France (H.H.).

9. Neuroradiology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (W.B.H.).

10. Neurology Department, CHU Rennes, France (T.A.-L.).

11. Neurology Department, Stroke Unit, Grenoble Alpes University Hospital, University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France (L.L.).

12. Stroke Unit, Bordeaux University Hospital, France (I.S.).

13. Stroke Unit, Strasbourg University Hospital, France (V.W.).

14. Neurology Department, CH Perpignan, France (D.S.).

15. Interventional Neuroradiology Department, Pitié-Salpétrière Hospital, Paris, France (M.E.).

16. Neurology Department, Faculty of Medicine, Tanta University, Egypt (M.E.).

17. Neurology Department, CHU Nantes, France (C.P.).

18. Neurology Department, André Mignot Hospital, Versailles, France (N.N.).

19. Neuroradiology Department, CHU Reims, France (S.S.).

20. Neurology Department, Foch Hospital, Suresnes, France (D.W.-L.).

21. Neurology Department, Rouen University Hospital, F-76000, Rouen, France (A.T.-B.).

22. Neurology Department, University Hospital of Nancy, France (G.M.).

23. Neurology Department, CHR Orléans, France (A.A.).

24. Neurology Department, CH Metropole Savoie, Chambery, France (J.P.).

25. Neurology Department, Rene Dubois Hospital, Pontoise, France (R.P.).

26. Neurology Department, CHU Dijon, France (Y.B.).

27. Neurology Department, Geneve University Hospital, Switzerland (E.C.).

28. Neurology Department, Stroke Unit, CHU St Etienne, France (P.G.).

29. Diagnostic and Interventional Radiology Department (G.S.), Lausanne University Hospital and University of Lausanne, Switzerland.

30. Netzwerk Radiology, Kantonsspital St. Gallen, Switzerland (P.M.).

31. Neuroradiology Department, Hospices Civils de Lyon, France (Y.B.).

32. Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France (V.C.).

33. Interventional Neuroradiology Department, CHU Lille, France (N.B.).

34. Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., P.S.).

35. Neurology Department, Lariboisière Hospital, APHP Nord, INSERM 1148, Université Paris Cité, Paris, France (M.M.).

36. FHU Neurovasc (M.M., G.T.).

37. Neurology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (G.T.).

38. Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR_S1266, Université Paris Cité, France (G.T., P.S.).

Abstract

Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown. Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0–2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0–1), symptomatic intracranial hemorrhage, and early neurological deterioration. Results: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63–82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4–10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66–1.01]; P =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95–1.43]; P =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35–4.67]; P =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64–3.84]; P <0.0001). Conclusions: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference21 articles.

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