Räty Silja, Nguyen Thanh N, Nagel Simon, Strambo Davide, Michel Patrik, Herweh Christian, Qureshi Muhammad M, Abdalkader Mohamad, Virtanen Pekka, Olive-Gadea Marta, Ribo Marc, Psychogios Marios, Nguyen Anh, Kuramatsu Joji B, Haupenthal David, Köhrmann Martin, Deuschl Cornelius, Escolà Jordi Kühne, Demeestere Jelle, Lemmens Robin, Vandewalle Lieselotte, Yaghi Shadi, Shu Liqi, Puetz Volker, Kaiser Daniel P O, Kaesmacher Johannes, Mujanovic Adnan, Marterstoc Dominique Cornelius, Engelhorn Tobias, Berberich Anne, Klein Piers, Haussen Diogo C, Mohammaden Mahmoud H, Abdelhamid Hend, Fragata Isabel, Cunha Bruno, Romoli Michele, Hu Wei, Song Jianlon, Fifi Johanna T, Matsoukas Stavros, Sheth Sunil A, Salazar-Marioni Sergio A, Marto João Pedro, Ramos João Nuno, Miszczuk Milena, Riegler Christoph, Poli Sven, Poli Khouloud, Jadhav Ashutosh P, Desai Shashvat, Maus Volker, Kaeder Maximilian, Siddiqui Adnan H, Monteiro Andre, Kokkonen Tatu, Diana Francesco, Masoud Hesham E, Suryadareva Neil, Mokin Maxim, Thanki Shail, Ylikotila Pauli, Alpay Kemal, Siegler James E, Linfante Italo, Dabus Guilherme, Yavaghal Dileep, Saini Vasu, Nolte Christian H, Siebert Eberhart, Möhlenbruch Markus A, Ringleb Peter A, Nogueira Raul G, Hanning Uta, Meyer Lukas, Fischer Urs, Strbian Daniel
Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Radiology, Boston Medical Center, Boston, MA, USA.
J Stroke. 2024 May;26(2):290-299. doi: 10.5853/jos.2024.00458. Epub 2024 May 30.
Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone.
From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0-1) and independent outcome (mRS 0-2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment.
Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3-P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79-1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05-2.12), sICH (aOR 2.87, 95% CI 1.23-6.72), and mortality (aOR 1.77, 95% CI 1.07-2.95).
Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.
大脑后动脉闭塞（PCAo）可导致长期残疾，但缺乏指导最佳再灌注策略的随机对照试验。我们比较了接受血管内血栓切除术（EVT）联合或不联合静脉溶栓（IVT）治疗的PCAo患者与单纯接受IVT治疗的患者的结局。
从多中心回顾性大脑后动脉闭塞（PLATO）登记处，我们纳入了2015年1月至2022年8月间发病24小时内接受再灌注治疗的孤立性PCAo患者。主要结局是3个月时改良Rankin量表（mRS）的分布。其他结局包括3个月时良好（mRS 0 - 1）和独立结局（mRS 0 - 2）、早期神经功能改善（ENI）、死亡率和症状性颅内出血（sICH）。使用逆概率加权回归调整对治疗进行比较。
在724例患者中，400例接受了EVT±IVT，324例仅接受IVT（中位年龄74岁，男性占57.7%）。入院时美国国立卫生研究院卒中量表评分中位数为7分，闭塞节段为P1（43.9%）、P2（48.3%）、P3 - P4（6.1%）、双侧（1.0%）或胎儿型大脑后动脉（0.7%）。与单纯IVT相比，EVT±IVT与功能结局改善无关（调整后的共同比值比[OR]为1.07，95%置信区间[CI]为0.79 - 1.43）。EVT增加了ENI（调整后的OR[aOR]为1.49，95% CI为1.05 - 2.12）、sICH（aOR为2.87，95% CI为1.23 - 6.72）和死亡率（aOR为1.77，95% CI为1.07 - 2.95）的几率。
尽管早期改善的几率较高，但与PCAo后单纯IVT相比，EVT±IVT并未影响功能结局。这可能是由EVT后sICH和死亡率风险增加所致。
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