Mechanical Thrombectomy for Posterior Circulation Occlusion: A Comparison of Outcomes with the Anterior Circulation Occlusion – A Meta-Analysis

Abstract

There is no randomized controlled trial to compare the effectiveness and safety of mechanical thrombectomy (MT) to intravenous thrombolysis in patients with posterior circulation occlusion (PCO). Hence, we firstly performed a meta-analysis to investigate the outcomes of MT in PCO and then compared these outcomes to anterior circulation occlusion (ACO) to provide fundamental data to further studies. Methods: We searched the PubMed, EMBASE, and Cochrane Library from dates of inception to June 2019 for relevant studies. Outcomes including functional independence at 90 days, successful recanalization, mortality, symptomatic intracranial hemorrhage (sICH), and futile recanalization were extracted. Results: Seven studies involving 474 patients with PCO thrombectomy were analyzed. There was a lower rate of functional independence at 90 days and a higher rate of mortality after thrombectomy in PCO versus ACO (odds ratios (OR) 0.72; 95% confidence interval (CI) 0.57-0.90; OR 2.03; 95% CI 1.30-3.18). Recanalization rates were comparable (OR 1.01; 95% CI 0.62-1.65), but a higher futile recanalization rate was found in basilar artery occlusion (BAO) (OR 1.75; 95% CI 1.30-2.37). There was a lower rate of sICH in MT for patients with PCO versus ACO (OR 0.54; 95% CI 0.29-0.99). Conclusions: We found that the outcomes of MT for patients with PCO were poorer than with ACO. On the other hand, MT appears to have lower rates of sICH and to increase successful recanalization. Given the high recanalization rate, MT may serve as an adjunct to standard treatment. The key point to improve outcomes is recognizing reliable factors associated with futile recanalization and optimizing the results of MT. But in view of the different characteristics of posterior circulation stroke and anterior circulation stroke, the results are far from robust. acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the new generations of mechanical thrombectomy (MT) devices compared to intravenous thrombolysis 2-6) , grounded on which American Heart Association/American Stroke Association guidelines Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion

“…Studies by previous meta-analyses showed no statistical difference between PCLVO and ACLVO in both recanalization success and 90 day functional outcome (19,20). A comparable likelihood of obtaining successful recanalization (Figure 8) and 90 day favorable functional outcome (Figure 10) was also found in our meta-analysis that included more recent studies.…”

“…To the best of our knowledge, until the conduction of this metaanalysis, there had been two prior meta-analyses comparing MT in anterior and posterior circulation stroke with both studies, however, focusing on MT safety and efficacy outcomes (19,20). This study, conducted independently from previous studies, included more recent literature on MT in PCLVO and ACLVO and, in a detailed meta-analysis, further sought to compare demographics and baseline characteristics, risk factors, as well as recanalization treatment profiles between the two brain circulations.…”

“…Data on the safety and efficacy of MT in PCLVO from the randomized controlled Basilar Artery International Cooperation Study (BASICS) and Basilar Artery Occlusion Chines Endovascular Trial (BAOCHE) trials are pending (17,18). Available data show a strong probability of differences in MT in PCLVO and ACLVO, which may contribute to their safety and efficacy outcomes (19,20). An improved functional outcome and reduced mortality in moderate-to-severe ACLVO stroke patients have been shown to be dependent on a small infarct core, moderateto-good collateral circulation, and rapid MT (21).…”

Prognostic Structural Neural Markers of MRI in Response to Mechanical Thrombectomy for Basilar Artery Occlusion

“…Accounting for only 1-4% of ischemic strokes, basilar artery occlusion (BAO) is a rare but devastating subtype of stroke, causing over 70% of deaths or a substantial part of severe disability in survivors (1), which has obtained abundant attention recently (2). In 2020, the results of the BEST randomized controlled trial and our real-world multicenter BASILAR research illustrated the improvement of mechanical thrombectomy (MT) for BAO (3,4).…”

“…In 2020, the results of the BEST randomized controlled trial and our real-world multicenter BASILAR research illustrated the improvement of mechanical thrombectomy (MT) for BAO (3,4). However, despite this progress, the current understanding of the prognostic imaging markers of BAO in response to MT was limited, due to the challenges faced in performing multi-modal magnetic resonance imaging (MRI), which were caused by the rare prevalence of BAO and the low usage rate of MRI in a preoperative examination (2).…”