Thrombectomy for acute large vessel occlusion in posterior and anterior circulation: a single institutional retrospective observational study

Abstract

Purpose Thrombectomy has been the gold standard therapy for anterior circulation occlusion; however, studies regarding thrombectomy in posterior circulation are lacking. In this study, we compared the efficiency of thrombectomy for acute large vessel occlusion between the posterior and anterior circulation at a single institution. Methods We retrospectively analyzed consecutive patients who underwent thrombectomy for acute large vessel occlusion at our institution between August 2014 and April 2021. Differences in the clinical background, time course, and treatment technique and outcomes were evaluated between anterior and posterior circulation occlusions. Results Overall, 353 patients (225 men and 128 women) were included: 314 patients had anterior circulation occlusion and 39 patients had posterior circulation occlusion. Between the patients with anterior and posterior circulation occlusions, the National Institutes of Health Stroke Scale (NIHSS) score (16 [12–21] vs. 29 [19–34], respectively, p < 0.001), door-to-puncture time (65 [45–99] vs. 99 [51–121] min, respectively, p = 0.018), and mortality (22 [7%] vs. 8 [20.5%] patients, respectively, p = 0.010) were significantly different; however, favorable outcome was not significantly different. Conclusion Higher NIHSS score, delayed treatment, and higher mortality were observed in posterior circulation occlusion than in anterior circulation occlusion; successful reperfusion and favorable outcomes were similar between them. Similar favorable outcomes and reperfusion ratio to the anterior circulation might be achieved also in the posterior circulation; however, delayed treatment and the optimal first-pass strategy might need further improvement.

Efficacy and safety of mechanical thrombectomy in the posterior cerebral circulation– a single center study

“…Therefore, the time from symptom onset to procedure might be longer in PMT compared with AMT. However, we did not observe such an association, in our patient cohort, which is consistent with ndings from other studies 5,8,12 . A meta-analysis demonstrated a signi cant difference in the time interval from symptom onset to the procedure, favoring AMT 7 .…”

“…We found no signi cant distinctions in reperfusion e ciency (TICI 2b-3), however the number of successful reperfusions was lower in the PMT group, as well as in other authors 5,6,8,12 . Additionally we did not identify signi cant differences in the duration of the MT; instead, the average duration of the procedure in the PMT group was slightly longer, as reported by other authors 6 .…”

“…These results imply that patients who underwent AMT initially presented with more severe neurological symptoms and were in a poorer overall condition compared to patients with PMT. Similarly, in a study by Schlemm et al 12 , patients with PMT had lower NIHSS2, whereas other results are presented in the literature in which NIHSS scores were signi cantly higher in the PMT group [5][6][7] .…”

“…al 8 . Nevertheless, increased mortality was observed in PMT in both: individual studies 5,6,13 and meta-analyzes 7,14 .…”

“…When comparing the e cacy, safety, and favorable outcomes of MT in the anterior (AMT) and posterior (PMT) circulation, studies often yield different results. While PMT is associated with higher mortality and a lower rate of functional independence on the 90th day 4 , successful reperfusion and favorable outcomes may be comparable in both the AMT and PMT groups [5][6][7] . Jahan et al demonstrated that PMT had similar rates of functional independence after 90 days, successful reperfusion, and mortality compared to AMT 8 .…”