Global Health Neurology Lab, Sydney, NSW, Australia.
South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia.
Acta Radiol. 2024 Aug;65(8):982-998. doi: 10.1177/02841851241255313. Epub 2024 Jun 5.
Posterior circulation stroke (PCS) accounts for approximately 20% of all acute ischemic strokes. The optimal reperfusion therapy for PCS management remains uncertain.
To evaluate the prevalence and outcomes of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and bridging therapy in PCS patients.
We conducted a meta-analysis of 19 studies examining reperfusion therapy outcomes in PCS patients, including 9765 individuals. We pooled prevalence data and assessed associations between reperfusion therapies and clinical, safety, and recanalization outcomes using random-effects models.
The pooled prevalence of reperfusion therapies post-acute PCS was 39% for IVT, 54% for EVT, and 48% for bridging therapy. EVT was associated with significantly higher odds of favorable functional outcomes (modified Rankin Score [mRS] 0-3) at 90 days compared to standard medical therapy (odds ratio [OR] = 5.68; 95% confidence interval [CI]=2.07-15.59; = 0.001). Conversely, bridging therapy was linked to reduced odds of favorable functional outcomes at 90 days compared to EVT (OR = 0.35; 95% CI=0.26-0.47; < 0.001). Bridging therapy was also significantly associated with lower odds of good functional outcomes (mRS 0-2) (OR = 0.25; 95% CI=0.11-0.54; < 0.001), reduced risk of symptomatic intracranial hemorrhage (OR = 0.26; 95% CI=0.07-0.68; = 0.009), lower mortality (OR = 0.13; 95% CI=0.04-0.44; = 0.001), and less successful recanalization (OR = 0.35; 95% CI=0.13-0.94; = 0.038) relative to EVT.
Our meta-analysis underscores the favorable outcomes associated with EVT in PCS cases. With notable reperfusion rates, understanding factors influencing PCS outcomes can inform patient selection and prognostic considerations.
后循环卒中（PCS）约占所有急性缺血性卒中的 20%。PCS 管理的最佳再灌注治疗仍不确定。
评估静脉溶栓（IVT）、血管内血栓切除术（EVT）和桥接治疗在 PCS 患者中的应用情况及结局。
我们对 19 项研究进行了荟萃分析，这些研究评估了 PCS 患者再灌注治疗的结局，共纳入 9765 例患者。我们汇总了再灌注治疗的流行率数据，并使用随机效应模型评估了再灌注治疗与临床、安全性和再通结局之间的关联。
急性 PCS 后再灌注治疗的流行率为 IVT 39%、EVT 54%和桥接治疗 48%。与标准药物治疗相比，EVT 治疗 90 天时具有更高的良好功能结局（改良 Rankin 量表[ mRS ] 0-3）的优势比（OR）为 5.68（95%CI=2.07-15.59； = 0.001）。相反，与 EVT 相比，桥接治疗与 90 天时良好功能结局的可能性降低相关（OR = 0.35；95%CI=0.26-0.47； < 0.001）。桥接治疗也与较低的良好功能结局（mRS 0-2）的可能性降低相关（OR = 0.25；95%CI=0.11-0.54； < 0.001）、症状性颅内出血风险降低（OR = 0.26；95%CI=0.07-0.68； = 0.009）、死亡率降低（OR = 0.13；95%CI=0.04-0.44； = 0.001）和再通成功率降低（OR = 0.35；95%CI=0.13-0.94； = 0.038）相关。
我们的荟萃分析强调了 EVT 在 PCS 病例中良好结局的相关性。鉴于较高的再灌注率，了解影响 PCS 结局的因素可以为患者选择和预后评估提供信息。
