From the Stroke Center, Neurology Service, Department of Clinical Neurosciences (D.S., J.P.M., G. Sirimarco, S.N., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland.
Department of Diagnostic and Interventional Radiology (B.B., V.D., G. Saliou), Lausanne University Hospital and University of Lausanne, Switzerland.
Stroke. 2020 Jan;51(1):254-261. doi: 10.1161/STROKEAHA.119.026907. Epub 2019 Nov 13.
Background and Purpose- We investigated efficacy and safety of acute revascularization with intravenous thrombolysis (IVT) and endovascular treatment (EVT) in ischemic stroke from isolated posterior cerebral artery occlusion, by assessing recanalization, disability, visual, cognitive outcomes, and hemorrhagic complications. Methods- For this retrospective single-center cohort study, we selected all consecutive patients with stroke with isolated posterior cerebral artery occlusion from the Acute Stroke Registry and Analysis of Lausanne registry between January 2003 and July 2018, and compared (1) IVT with conservative treatment (CTr) and (2) EVT to best medical therapy (BMT, ie, CTr or IVT) in terms of 3-month disability and visual field defect, and cognitive domains impaired after stroke. Unadjusted analysis, multivariable logistic regression, and propensity score matched analyses were performed. Results- Among 106 patients with isolated posterior cerebral artery occlusion, 21 received EVT (13 bridging), 34 IVT alone, and 51 CTr. Median age was 76 years, 47% were female and median National Institutes of Health Stroke Scale score was 7. Complete 24-hour recanalization was more frequent with IVT than CTr (51% versus 9%; OR [95% CI]=10.62 [2.13-52.92]) and with EVT compared with BMT (68% versus 34%; OR [95% CI]=4.11 [1.35-12.53]). Higher proportions of good disability, visual and cognitive outcomes were observed in IVT versus CTr, ORs (95% CI)=1.65 (0.60-4.52), 2.01 (0.58-7.01), 2.94 (0.35-24.4), respectively, and in EVT versus BMT, ORs (95% CI)=1.44 (0.51-4.10), 4.28 (1.00-18.29), 4.37 (0.72-26.53), respectively. Hemorrhagic complications and mortality did not increase with IVT or EVT. Conclusion s-We show increased odds of recanalization following IVT and even higher after EVT. We observed a trend for a positive effect on disability, visual, and cognitive outcomes with IVT over CTr and with EVT over BMT.
我们通过评估再通率、残疾、视力、认知结果和出血并发症，研究了急性血管内溶栓（IVT）和血管内治疗（EVT）对孤立性大脑后动脉闭塞性缺血性卒中的疗效和安全性。方法：本回顾性单中心队列研究，入选了 2003 年 1 月至 2018 年 7 月急性卒中登记和洛桑分析登记中所有连续的孤立性大脑后动脉闭塞卒中患者，比较了（1）IVT 联合保守治疗（CTr）与（2）EVT 联合最佳药物治疗（BMT，即 CTr 或 IVT）对 3 个月时残疾和视野缺损，以及卒中后受损的认知域的影响。进行了未调整分析、多变量逻辑回归和倾向评分匹配分析。结果：在 106 例孤立性大脑后动脉闭塞患者中，21 例接受了 EVT（13 例桥接），34 例单独接受 IVT，51 例接受 CTr。中位年龄为 76 岁，47%为女性，中位国立卫生研究院卒中量表评分为 7 分。与 CTr 相比，IVT 更易实现 24 小时完全再通（51%比 9%；OR [95%CI]=10.62 [2.13-52.92]），与 BMT 相比，EVT 更易实现（68%比 34%；OR [95%CI]=4.11 [1.35-12.53]）。与 CTr 相比，IVT 治疗后的残疾、视力和认知结局更好，OR（95%CI）分别为 1.65（0.60-4.52）、2.01（0.58-7.01）、2.94（0.35-24.4），与 BMT 相比，EVT 治疗后的残疾、视力和认知结局更好，OR（95%CI）分别为 1.44（0.51-4.10）、4.28（1.00-18.29）、4.37（0.72-26.53）。IVT 或 EVT 并未增加出血并发症和死亡率。结论：我们发现 IVT 后再通的几率增加，EVT 后甚至更高。与 CTr 相比，IVT 治疗后残疾、视力和认知结局有改善趋势，与 BMT 相比，EVT 治疗后也有改善趋势。
