Lee Seong-Joon, Hong Ji Man, Kim Jong S, Lee Jin Soo
Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Stroke. 2022 May;24(2):207-223. doi: 10.5853/jos.2022.00941. Epub 2022 May 31.
The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Studies have shown that patients undergoing PC-EVT had a higher rate of futile recanalization than those undergoing EVT for anterior circulation stroke. These findings call for further identification of prognostic factors beyond recanalization. The significance of baseline clinical severity, infarct volume, collaterals, time metrics, core-penumbra mismatch, and methods to accurately measure these parameters are discussed. Furthermore, their interplay on EVT outcomes and the potential to individualize patient selection for PC-EVT are reviewed. We also discuss technical considerations for improving the treatment efficacy of PC-EVT.
血管内治疗（EVT）对后循环卒中患者的疗效尚未得到证实。最近的两项随机对照试验未能显示出血管内治疗后循环卒中（PC-EVT）后功能结局得到改善。然而，最近的一次会议上也公布了另外两项随机对照试验的有前景的结果。研究表明，接受PC-EVT的患者与接受前循环卒中血管内治疗的患者相比，无效再通率更高。这些发现要求进一步识别除再通之外的预后因素。讨论了基线临床严重程度、梗死体积、侧支循环、时间指标、核心-半暗带不匹配以及准确测量这些参数的方法的重要性。此外，还综述了它们对EVT结局的相互作用以及为PC-EVT个体化选择患者的潜力。我们还讨论了提高PC-EVT治疗疗效的技术考量。
