Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site-Reference-Cited by-同舟云学术

Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site

Published:2024-07 Issue:7 Volume:55 Page:1787-1797
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Strambo Davide¹^ORCID,Michel Patrik¹^ORCID,Nguyen Thanh N.²³^ORCID,Abdalkader Mohamad³^ORCID,Qureshi Muhammad M.³⁴^ORCID,Strbian Daniel⁵^ORCID,Herweh Christian⁶^ORCID,Möhlenbruch Markus A.⁶,Räty Silja⁵^ORCID,Olivé-Gadea Marta⁷,Ribo Marc⁷,Psychogios Marios⁸,Fischer Urs⁹¹⁰,Nguyen Anh⁸,Kuramatsu Joji B.¹¹,Haupenthal David¹¹,Köhrmann Martin¹²,Deuschl Cornelius¹³,Kühne Escolà Jordi¹²,Demeestere Jelle¹⁴¹⁵,Lemmens Robin¹⁴¹⁵,Vandewalle Lieselotte¹⁴¹⁵,Yaghi Shadi¹⁶,Shu Liqi¹⁶,Puetz Volker¹⁷¹⁸,Kaiser Daniel P.O.¹⁹¹⁸,Kaesmacher Johannes²⁰,Mujanovic Adnan²⁰,Marterstock Dominique Cornelius²¹,Engelhorn Tobias²¹,Requena Manuel¹⁹,Dasenbrock Hormuzdiyar H.³,Klein Piers³,Haussen Diogo C.²²,Mohammaden Mahmoud H.²²,Abdelhamid Hend²²,Souza Viana Lorena²²,Cunha Bruno²³,Fragata Isabel²³²⁴,Romoli Michele²⁵,Diana Francesco²⁶,Hu Wei²⁷,Zhang Chao²⁷,Virtanen Pekka²⁸,Lauha Riikka²⁸,Jesser Jessica⁶,Clark Judith²,Matsoukas Stavros²⁹,Fifi Johanna T.²⁹,Sheth Sunil A.³⁰,Salazar-Marioni Sergio³⁰,Marto João Pedro³¹,Ramos João Nuno³²,Miszczuk Milena³³,Riegler Christoph³⁴,Poli Sven³⁵³⁶,Poli Khouloud³⁵³⁶,Jadhav Ashutosh P.³⁷,Desai Shashvat M.³⁷,Maus Volker³⁸³⁹,Kaeder Maximilian³⁸,Siddiqui Adnan H.³,Monteiro Andre⁴⁰,Masoud Hesham E.⁴¹,Suryadareva Neil⁴²,Mokin Maxim⁴³,Thanki Shail⁴³,Alpay Kemal⁴⁴,Ylikotila Pauli⁴⁵,Siegler James E.⁴⁶,Linfante Italo⁴⁷,Dabus Guilherme⁴⁷,Asdaghi Negar⁴⁸,Saini Vasu⁴⁸,Nolte Christian H.³⁴,Siebert Eberhard³³,Serrallach Bettina L.²⁰,Weyland Charlotte S.⁴⁹,Hanning Uta⁵⁰,Meyer Lukas⁵⁰,Berberich Anne⁵¹,Ringleb Peter A.⁵²,Nogueira Raul G.⁴²,Nagel Simon

Affiliation:

1. Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Switzerland (D. Strambo, P.M.).

2. Neurology (T.N.N., J.C.), Boston Medical Center, MA.

3. Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.

4. Radiation Oncology (M.M.Q.), Boston Medical Center, MA.

5. Neurology (D. Strbian, S.R.), Helsinki University Hospital, University of Helsinki, Finland.

6. Neuroradiology (C.H., M.A.M., J.J.), Heidelberg University Hospital, Germany.

7. Neurology, Hospital Universitario Vall d’Hebron, Barcelona, Spain (M.O.-G., M. Ribo, M. Requena).

8. Radiology, Basel University Hospital, University of Basel, Switzerland (M.P., A.N.).

9. Department of Neurology, University Hospital and University of Bern, Switzerland (U.F.).

10. Department of Neurology, University Hospital and University of Basel, Switzerland (U.F.).

11. Neurology (J.B.K, D.H.), University of Erlangen-Nuremberg, Germany.

12. Neurology, Institute of Diagnostic and Interventional Radiology (M. Köhrmann, J.K.E.), University Hospital Essen, Germany.

13. Neuroradiology (C.D.), University Hospital Essen, Germany.

14. Neurology, UZ Leuven, Belgium (J.D., R. Lemmens, L.V.).

15. Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R. Lemmens, L.V.).

16. Neurology, Rhode Island Hospital (S.Y., L.S.).

17. Neurology (V.P.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

18. Dresden University Stroke Center (V.P., D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

19. Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

20. Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J.K., A. Mujanovic, B.S.).

21. Neuroradiology (D.C.M., T.E.), University of Erlangen-Nuremberg, Germany.

22. Neurology, Grady Memorial Hospital (D.C.H., M.H.M., H.A., L.S.V.).

23. Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.).

24. NOVA Medical School, Universidade Nova de Lisboa, Portugal (I.F.).

25. Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli).

26. Neuroradiology, University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, Salerno, Italy (F.D.).

27. Neurology, The First Affiliated Hospital of USTC, Hefei, China (W.H., C.Z.).

28. Radiology (P.V., R. Lauha, K.L.), Helsinki University Hospital, University of Helsinki, Finland.

29. Neurosurgery, Mount Sinai Health System (S.M., J.T.F.).

30. Neurology, McGovern Medical School at UTHealth, TX (S.A.S., S.S.-M.).

31. Neurology (J.P.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.

32. Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.

33. Neuroradiology (M. Miszczuk, E.S.), Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

34. Departement of Neurology and Experimental Neurology, and Center for Stroke Research Berlin (C.R., C.H.N.), Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

35. Department of Neurology and Stroke (S.P., K.P.), University of Tübingen, Germany.

36. Hertie Institute for Clinical Brain Research (S.P., K.P.), University of Tübingen, Germany.

37. Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.).

38. Radiology, Neuroradiology, and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M.K.).

39. Institute of Radiology and Neuroradiology, Klinikum Aschaffenburg, Germany (V.M.).

40. Neurosurgery, University of Buffalo, NY (A.H.S., A. Monteiro).

41. Neurology, New York Upstate Medical University (H.E.M.).

42. Neurology, University of Pittsburgh Medical Center, PA (N.S., R.G.N.).

43. Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.).

44. Radiology (K.A.), Turku University Hospital, Finland.

45. Neurology (P.Y.), Turku University Hospital, Finland.

46. Neurology, University of Chicago, IL (J.E.S.).

47. Miami Neuroscience Institute, FL (I.L., G.D.).

48. Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.).

49. Neuroradiology, University Hospital RWTH Aachen, Germany (C.S.W.).

50. Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.).

51. Neurology, Klinikum Ludwigshafen, Germany (A.B., S.N.).

52. Neurology (P.A.R., S.N.), Heidelberg University Hospital, Germany.

Abstract

BACKGROUND: Acute ischemic stroke with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO acute ischemic stroke is modified by initial stroke severity (baseline National Institutes of Health Stroke Scale [NIHSS]) and arterial occlusion site. METHODS: Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0–1), functional independence (mRS score 0–2), symptomatic intracranial hemorrhage, and mortality. RESULTS: From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution ( P interaction =0.312) but did with functional independence ( P interaction =0.010), with a similar trend on excellent outcome ( P interaction =0.069). EVT was associated with more favorable outcomes than MM in patients with baseline NIHSS score >6 (mRS score 0–1, 30.6% versus 17.7%; adjusted odds ratio [aOR], 2.01 [95% CI, 1.22–3.31]; mRS score 0 to 2, 46.1% versus 31.9%; aOR, 1.64 [95% CI, 1.08–2.51]) but not in those with NIHSS score ≤6 (mRS score 0–1, 43.8% versus 46.3%; aOR, 0.90 [95% CI, 0.49–1.64]; mRS score 0–2, 65.3% versus 74.3%; aOR, 0.55 [95% CI, 0.30–1.0]). EVT was associated with more symptomatic intracranial hemorrhage regardless of baseline NIHSS score ( P interaction =0.467), while the mortality increase was more pronounced in patients with NIHSS score ≤6 ( P interaction =0.044; NIHSS score ≤6: aOR, 7.95 [95% CI, 3.11–20.28]; NIHSS score >6: aOR, 1.98 [95% CI, 1.08–3.65]). Arterial occlusion site did not modify the association of EVT with outcomes compared with MM. CONCLUSIONS: Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference21 articles.

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2. Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery

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4. Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry

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

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