Sabben Candice, Charbonneau Frédérique, Delvoye François, Strambo Davide, Heldner Mirjam R, Ong Elodie, Ter Schiphorst Adrien, Henon Hilde, Ben Hassen Wagih, Agasse-Lafont Thomas, Legris Loïc, Sibon Igor, Wolff Valérie, Sablot Denis, Elhorany Mahmoud, Preterre Cécile, Nehme Nour, Soize Sébastien, Weisenburger-Lile David, Triquenot-Bagan Aude, Mione Gioia, Aignatoaie Andreea, Papassin Jérémie, Poll Roxana, Béjot Yannick, Carrera Emmanuel, Garnier Pierre, Michel Patrik, Saliou Guillaume, Mordasini Pasquale, Berthezene Yves, Costalat Vincent, Bricout Nicolas, Albers Gregory W, Mazighi Mikael, Turc Guillaume, Seners Pierre
Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France.
Neuroradiology Department (F.C.), Rothschild Foundation Hospital, Paris, France.
Stroke. 2023 Apr;54(4):928-937. doi: 10.1161/STROKEAHA.122.042283. Epub 2023 Feb 2.
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.
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.
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]; =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95-1.43]; =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35-4.67]; =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64-3.84]; <0.0001).
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.
与单纯最佳药物治疗（BMM）相比，在BMM基础上加用血管内治疗（EVT）对孤立性大脑后动脉闭塞的急性缺血性卒中是否有益尚不清楚。
我们在26个卒中中心对症状发作后6小时内入院的连续性卒中患者进行了一项多中心国际观察性研究，这些患者存在大脑后动脉第一（P1）或第二（P2）段的孤立性闭塞，接受了BMM + EVT或单纯BMM治疗。采用倾向评分与治疗权重的逆概率来解释组间基线差异。主要结局是3个月时良好的功能结局（改良Rankin量表[mRS]评分0 - 2或恢复到基线改良Rankin量表）。次要结局包括3个月时的优异恢复（改良Rankin量表评分0 - 1）、有症状的颅内出血和早期神经功能恶化。
总体而言，共纳入752例患者（BMM + EVT组167例，单纯BMM组585例）。中位年龄为74岁（四分位间距，63 - 82岁），329例（44%）患者为女性，国立卫生研究院卒中量表中位评分为6分（四分位间距4 - 10分），188例（25%）患者闭塞部位为P1，564例（75%）患者为P2。倾向评分加权后，两组间基线临床和影像学数据相似。EVT与良好功能结局的较低几率呈趋势性相关（优势比，0.81 [95% CI，0.66 - 1.01]；P = 0.06），与优异功能结局无关（优势比，1.17 [95% CI，0.95 - 1.43]；P = 0.15）。EVT与有症状颅内出血的较高风险相关（优势比，2.51 [95% CI，1.35 - 4.67]；P = 0.004）和早期神经功能恶化相关（优势比，2.51 [95% CI，1.64 - 3.84]；P < 0.0001）。
在这项对大脑后动脉近端闭塞患者的观察性研究中，与单纯BMM相比，EVT与良好或优异的功能结局无关。然而，EVT与有症状颅内出血和早期神经功能恶化的发生率较高相关。在该人群中不应常规推荐EVT，但非常有必要将其随机纳入临床试验。
