Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry
Brouwer, Josje; Ergezen, Saliha; Mulder, Maxim Johan Heymen Laurence; Lycklama A Nijeholt, Geert J; van Es, Adriaan C G M; van der Lugt, Aad; Dippel, Diederik W J; Majoie, Charles B L M; Roos, Yvo B W E M; Coutinho, J M; Emmer, Bart J; MR CLEAN Registry Investigators; van der worp, B; Lo, Rob; Zweedijk, Berber
(2023) Journal of NeuroInterventional Surgery, volume 15, issue 4, pp. 363 - 369
(Article)
Abstract
BACKGROUND: Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit. OBJECTIVE: To describe in a prospective study the clinical manifestations, outcomes, and
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safety of EVT in isolated PCA occlusions. METHODS: We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (ΔNIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications. RESULTS: Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ΔNIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred. CONCLUSIONS: EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
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Keywords: United States, Humans, Female, Aged, Male, Stroke/diagnostic imaging, Brain Ischemia/therapy, Prospective Studies, Ischemic Stroke/complications, Posterior Cerebral Artery, Intracranial Hemorrhages/etiology, Cerebrovascular Disorders/complications, Arterial Occlusive Diseases/diagnostic imaging, Cerebral Infarction/complications, Registries, Journal Article
ISSN: 1759-8478
Publisher: BMJ Publishing Group
Note: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
(Peer reviewed)