Thrombectomy and Thrombolysis of Isolated Posterior Cerebral Artery Occlusion: Cognitive, Visual and Disability Outcomes.

Strambo, Davide; Bartolini, Bruno; Beaud, Valérie; Nannoni, Stefania; Gaia, Silvia; Dunet, Vincent; Marto, João Pedro; Saliou, Guillaume; Michel, Patrik

doi:10.26226/morressier.5cb58cf7c668520010b567b9

Cited by 8 publications

(24 citation statements)

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“…For proximal PCA occlusion (P1 or P2 segments), retrospective analyses have shown trends toward better outcomes with EVT versus best medical treatment (which may include IVT). 24 A similar result was observed in the TOPMOST study evaluating distal PCA occlusions (P2 and P3 segments). 25 None of these studies showed an increase in symptomatic ICH with EVT.…”

Section: Acute Managementsupporting

confidence: 79%

Treatment of posterior circulation stroke: Acute management and secondary prevention

Markus

Michel

2022

International Journal of Stroke

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One fifth of strokes occur in the territory of the posterior circulation but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, have received much less attention than similar interventions for the anterior circulation. In this review we overview treatment of posterior circulation stroke, including both interventions in the acute setting and, secondary prevention. We focus on areas in which management of posterior circulation stroke differs from that of stroke in general, and highlight recent advances. Effectiveness of acute revascularisation of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower haemorrhage risks than in the anterior circulation. The recent ATTENTION and BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar artery occlusion, but its effect on other posterior occlusion sites remains uncertain. Ischaemic and haemorrhagic space-occupying cerebellar strokes can benefit from decompressive craniectomy Secondary prevention of posterior circulation strokes includes aggressive treatment of cerebrovascular risk factors with both drugs and lifestyle interventions, and short term dual antiplatelet therapy. Randomised controlled trial (RCT) data suggest basilar artery stenosis is better treated with medical therapy than stenting, which has a high peri-procedural risk. Limited data from RCTs in stenting for vertebral stenosis suggest intracranial stenosis is currently best treated with medical therapy alone; the situation for extracranial stenosis is less clear where stenting for symptomatic stenosis is an option, particularly for recurrent symptoms; larger RCTs are required in this area.

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Section: Acute Managementsupporting

confidence: 79%

Treatment of posterior circulation stroke: Acute management and secondary prevention

Markus

Michel

2022

International Journal of Stroke

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“…The largest retrospective study indicated a better cognitive and visual outcome with effective recanalization treatments like EVT. 37…”

Section: Prognosis In Posterior Circulation Strokesmentioning

confidence: 99%

Patterns of ischemic posterior circulation strokes: A clinical, anatomical, and radiological review

Salerno

Strambo

Nannoni

et al. 2021

International Journal of Stroke

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Background Posterior circulation and anterior circulation strokes share many clinical, pathogenetic and radiological features, although some clinical signs are highly specific to posterior circulation strokes. Arterial stenosis and occlusions occur in significant numbers in both acute posterior circulation and anterior circulation strokes, making them good candidates for endovascular treatment. Among posterior circulation strokes, basilar artery occlusions stand out because of the diagnostic and acute treatment challenges. Methods We reviewed the literature on clinical stroke syndromes and neuroimaging findings and systematically describe for each anatomical site of stroke the detailed clinical and radiological information (anatomical representation, diffusion weighted imaging and angiographic sequences). The principles of neuroimaging of posterior circulation strokes and the prognosis for each stroke localization are also discussed. Review summary Stroke syndromes in the territories of the vertebral, basilar, cerebellar, and posterior cerebral arteries are presented. Features typical of posterior circulation strokes are highlighted, including patterns of basilar artery occlusions. Clinical severity and prognosis of posterior circulation strokes are highly variable, and given that they are more difficult to detect on CT-based neuroimaging, magnetic resonance imaging is the technique of choice in suspected posterior circulation strokes. Rapid identification of arterial occlusion patterns may provide prognostic information and support acute revascularization decisions. Conclusions Posterior circulation stroke syndromes tightly reflect lesion localization and arterial occlusion patterns. Although many clinical and pathogenetic features are similar to anterior circulation strokes, notable differences exist in terms of clinical presentation, stroke mechanism, prognosis, and response to acute recanalization.

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“…Patients with PCA occlusion strokes may experience disabling symptoms including visual field defects, cognitive dysfunction, and hemisensory symptoms or hemiparesis in more proximal occlusions [3]. Although clinical symptoms of PCA infarcts may result in a low National Institute of Health Stroke Scale (NIHSS) score, they can severely impact a patient's functional independence and quality of life [1, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review andmeta‐analysis

Berberich

Finitsis

Strambo

et al. 2022

Euro J of Neurology

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Background and purpose Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study‐level meta‐analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0–2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results Twelve studies with a total of 679 patients were included in the meta‐analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83–70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35–55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30–20.93) and 12.3% (95% CI 8.64–17.33). sICH occurred in 4.2% (95% CI 2.47–7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75–5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.

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Thrombectomy and Thrombolysis of Isolated Posterior Cerebral Artery Occlusion: Cognitive, Visual and Disability Outcomes.

Cited by 8 publications

References 0 publications

Treatment of posterior circulation stroke: Acute management and secondary prevention

Treatment of posterior circulation stroke: Acute management and secondary prevention

Patterns of ischemic posterior circulation strokes: A clinical, anatomical, and radiological review

Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review andmeta‐analysis

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