Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Curr Opin Neurol. 2024 Feb 1;37(1):26-31. doi: 10.1097/WCO.0000000000001234. Epub 2023 Dec 12.
This review highlights the latest advancements achieved in the revascularization of arterial occlusions associated with an acute ischemic stroke affecting the posterior circulation. It delves into the frequency and outcomes based on specific arterial segments and presents current evidence supporting revascularization treatments, including intravenous thrombolysis and endovascular thrombectomy.
Comprehensive evidence for treatment across major arterial segments of the posterior circulation -- vertebral artery, basilar artery, posterior cerebral artery, cerebellar arteries, and multilevel posterior occlusions -- is provided. Additionally, the latest findings from randomized clinical trials on basilar artery occlusion are explored alongside results from extensive retrospective analyses of isolated vertebral and posterior cerebral artery occlusions.
Current research supports the treatment decision in acute ischemic strokes of the posterior circulation using both intravenous thrombolysis and endovascular thrombectomy. This review also emphasizes existing knowledge gaps in the management of these strokes and advocates for more randomized clinical trials, notably concerning the posterior cerebral artery (currently ongoing), isolated vertebral artery, and multilevel posterior circulation occlusions.
本文重点介绍了与影响后循环的急性缺血性脑卒中相关的动脉闭塞再通方面的最新进展。文中探讨了基于特定动脉节段的再通频率和结果，并介绍了支持再通治疗的最新证据，包括静脉溶栓和血管内血栓切除术。
提供了后循环主要动脉节段（椎动脉、基底动脉、大脑后动脉、小脑动脉和多水平后循环闭塞）的治疗综合证据。此外，还探讨了随机临床试验在基底动脉闭塞方面的最新发现，以及对孤立的椎动脉和大脑后动脉闭塞的广泛回顾性分析结果。
目前的研究支持使用静脉溶栓和血管内血栓切除术治疗后循环急性缺血性脑卒中。本文还强调了这些脑卒中管理方面存在的知识空白，并提倡进行更多的随机临床试验，特别是针对大脑后动脉（目前正在进行中）、孤立的椎动脉和多水平后循环闭塞。
