A Case of Acute Isolated Posterior Cerebral Artery Occlusion Successfully Treated with Endovascular Clot Aspiration

Yamamoto, Taiki; Ohshima, Tomotaka; Satō, Masaki; Goto, Shunsaku; Ishikawa, Kojiro; Nishizawa, Tsutomu; Shimato, Shinji; Kato, Kyozo

doi:10.2176/nmccrj.cr.2016-0214

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…This might be partly explained by the fact that all the patients involved in our study had a proximal (P1 or P2) PCA occlusion, but also probably by the fact that the treatment decision in our study was left to the discretion of the medical team, leading potentially to subjective selection of patients with more severe deficits. Only limited data are available in the literature on the safety and effectiveness of MT in PCA occlusions: mainly case reports, either of regular [8] or foetal [20] PCA configurations, and short case series in which PCA occlusions were merged with other posterior circulation occlusions [21]. In a recent study comparing anterior and posterior circulation strokes [21], only six (4.3%) isolated PCA occlusions were reported and 23 cases (16.5%) of PCA or vertebral artery occlusions combined with basilar artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…However, data regarding the safety and effectiveness of MT in patients with AIS related to PCA occlusion are lacking. There have been limited reports for treating this condition to date [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…The modified Rankin Scale at 90 days was assessed. Results: Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range [8][9][10][11][12][13][14][15][16]. Stroke aetiology was cardio-embolic in 68.2% of cases.…”

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confidence: 99%

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Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Clarençon

Baronnet

Shotar

et al. 2020

Euro J of Neurology

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Background and purpose: The purpose of this study was to evaluate the safety and effectiveness of mechanical thrombectomy (MT) in patients with acute ischaemic stroke related to isolated and primary posterior cerebral artery (PCA) occlusions amongst the patients enrolled in the multicentre post-market Trevo Registry. Method: Amongst the 2008 patients enrolled in the Trevo Registry with acute ischaemic stroke due to large vessel occlusion treated by MT, 22 patients (1.1%) [10 females (45.5%), mean age 66.2 AE 14.3 years (range 28-91)] had a PCA occlusion [17 P1 (77.3%) and five P2 occlusions (22.7%)]. Recanalization after the first Trevo (Stryker, Fremont, CA, USA) pass and at the end of the procedure was rated using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Procedure-related complications (i.e. groin puncture complication, perforation, symptomatic haemorrhage, embolus in a new territory) were also recorded. The modified Rankin Scale at 90 days was assessed. Results: Median National Institutes of Health Stroke Scale at admission was 14 (interquartile range 8-16). Stroke aetiology was cardio-embolic in 68.2% of cases. Half of the patients (11/22) received intravenous tissue plasminogen activator. 54.5% of the patients were treated under general anaesthesia. Reperfusion (i.e. mTICI 2b or 3) after first pass was obtained in 65% of cases. Final mTICI 2b-3 reperfusion was obtained in all cases. Only one (4.5%) procedure-related complication was recorded (puncture site) that resolved after surgery. At 90-day follow-up, modified Rankin Scale 0-2 was obtained in 59% of the patients and 9.1% died within the first 3 months after MT. Conclusion: Mechanical thrombectomy for PCA occlusions seems to be safe (<5% procedure-related complications) and effective. Larger repository datasets are needed.Correspondence: F. Clarenc ßon,

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Clarençon

Baronnet

Shotar

et al. 2020

Euro J of Neurology

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“…Nevertheless, data on safety and efficacy of intravenous thrombolytic therapy in the patients with stroke associated with PCA region support its administration. As a conclusion, the patients without a contraindication should be treated with IV t-PA within 4.5 hours from the onset of signs and symptoms for acute ischemic stroke associated with PCA region [3].…”

Section: Resultsmentioning

confidence: 99%

“…Cerebral infarctions in the posterior cerebral artery (PCA) region are not rare. Many patients may experience various unidentifiable symptoms at the moment of PCA infarction, as a consequence, they may not describe clear signs and symptoms accurately [3].…”

Section: Resultsmentioning

confidence: 99%

IV Administration of Thrombolytic Therapy in a Case with Hemianopsia Symptoms

Haki

Gümüştaş²,

Ali

et al. 2019

JAMMR

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Intravenous thrombolytic therapy is useful also in the treatment of very mild ischemic strokes. The recent FDA guidelines have approved that IV administration of recombinant tissue plasminogen activator (rtPA) should be performed in the cases with NIHSS<5 despite its potential risks. The administration of IV thrombolytic therapy is recommended also in the patients with aphasia or hemianopsia. In routine clinical practice, there is a tendency to avoid thrombolytic therapy in the case with only low NIHSS score, aphasia or hemianopsia to eliminate the potential risks. Hemianopsia may significantly affect the daily life of young and active patients. In this paper, we have reported a case who was brought to emergency service due to the complaint of visual impairment and administered IV thrombolytic therapy for partial homonymous hemianopsia only on the left side detected by neurological examination.

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Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

et al. 2021

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IMPORTANCE Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse.OBJECTIVE To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. DESIGN, SETTING, AND PARTICIPANTSThis multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. INTERVENTIONS Mechanical thrombectomy or standard medical treatment with or without IVT.MAIN OUTCOMES AND MEASURES Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. RESULTSOf 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was −2.4 points (95% CI, −3.2 to −1.6) in the standard medical treatment cohort and −3.9 points (95% CI, −5.4 to −2.5) in the mechanical thrombectomy cohort, with a mean difference of −1.5 points (95% CI, 3.2 to −0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, −5.6; 95% CI, −10.9 to −0.2; P = .04) and in the subgroup of patients without IVT (mean difference, −3.0; 95% CI, −5.0 to −0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort.CONCLUSIONS AND RELEVANCE This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

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A Case of Acute Isolated Posterior Cerebral Artery Occlusion Successfully Treated with Endovascular Clot Aspiration

Cited by 9 publications

References 21 publications

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo Registry

IV Administration of Thrombolytic Therapy in a Case with Hemianopsia Symptoms

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

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