College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Eur Stroke J. 2024 Mar;9(1):69-77. doi: 10.1177/23969873231201715. Epub 2023 Sep 26.
Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO.
We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) using a random-effects model.
Seven studies involving 2560 patients were included. EVT was associated with significantly higher likelihood of early neurological improvement (OR, 2.31 [95% CI, 1.38-2.91]; < 0.00001) and visual field normalization (OR, 3.08 [95% CI, 1.76-5.38]; < 0.0001) compared to BMM. Rates of good functional outcomes (mRS 0-2) were comparable between the two arms (OR, 0.88 [95% CI, 0.70-1.10]; = 0.26). Symptomatic intracranial hemorrhage (sICH) was comparable between the two groups (OR, 1.94 [95% CI, 0.96-3.93]; = 0.07). Mortality was also similar between the two groups (OR, 1.36; [95% CI, 0.77-2.42]; = 0.29).
In patients with iPCAO, EVT was associated with visual and early neurological improvement but with a strong trend toward increased sICH. Survival and functional outcomes may be slightly poorer. The role of EVT in iPCAO remains uncertain.
在缺血性脑卒中血管内血栓切除术（EVT）的关键随机临床试验（RCT）中，孤立性大脑后动脉闭塞（iPCAO）的代表性不足，EVT 在这一人群中的获益仍不确定。我们进行了一项系统评价和荟萃分析，以比较 EVT 与最佳药物治疗（BMM）在 iPCAO 患者中的安全性和疗效。
我们检索了 Medline/PubMed、Embase、Web of Science 和 Cochrane 数据库，以获取截至 2023 年 5 月报告接受 EVT 或 BMM 治疗的 iPCAO 患者结局的研究。我们使用随机效应模型汇总了比值比（OR）及其相应的 95%置信区间（CI）。
纳入了 7 项涉及 2560 名患者的研究。与 BMM 相比，EVT 更有可能早期改善神经功能（OR，2.31 [95% CI，1.38-2.91]； < 0.00001）和视野正常化（OR，3.08 [95% CI，1.76-5.38]； < 0.0001）。两组之间良好的功能结局（mRS 0-2）的发生率相似（OR，0.88 [95% CI，0.70-1.10]； = 0.26）。两组之间症状性颅内出血（sICH）的发生率相似（OR，1.94 [95% CI，0.96-3.93]； = 0.07）。两组之间的死亡率也相似（OR，1.36；95% CI，0.77-2.42]； = 0.29）。
在 iPCAO 患者中，EVT 与视觉和早期神经功能改善相关，但 sICH 发生率有升高的趋势。生存和功能结局可能略差。EVT 在 iPCAO 中的作用仍不确定。
