Thrombectomy of symptomatic isolated occlusions of posterior cerebral arteries in segment P1 and P2 in acute stroke treatment

Abstract

Background Interventional stroke treatments for occlusions of the posterior circulation are established procedures. However, there are limited data on the treatment of isolated symptomatic P1 and P2 occlusions, which we have examined in this study. Purpose To investigate the mechanical thrombectomy of distal posterior occlusions Material and Methods Retrospectively, data from patients with isolated P1 and P2 occlusions treated with MT were evaluated. Successful reperfusions have been defined as modified thrombolysis in cerebral infarct (mTICI) Grade 2b–3. A good clinical outcome was defined as a 90-day modified Rankin score 0–2. Results All 79 treated patients were primarily aspirated. Stent retrievers were used secondarily in nine patients. Successful reperfusion was achieved in 95% of patients. Of the patients, 57% had a favorable clinical outcome after 90 days. Conclusion Mechanical thrombectomy with first line aspiration of symptomatic P1 and P2 occlusions is a safe and effective procedure.

Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion

“…[ 13 ] 2021 Portugal Single-center retrospective cohort 38 P1 ( n = 19), P2 ( n = 16), P3 ( n = 3) 25 79.3 (±2.4) 16/9 10 (6.0–14.5) 14 (56%) Stent retriever; aspiration thrombectomy; intra-arterial thrombolysis 13 75.3 (±3.93) 7/6 8 (5.5–10.0) 13 (100%) Altenbernd et al. [ 14 ] 2021 Germany Single-center retrospective cohort 79 P1 ( n = 60), P2 ( n = 19) 79 72.8 (±11.6) 35/44 12 (4–15) 43 (54%) Stent retriever; aspiration thrombectomy – – – – – Herweh et al. [ 15 ] 2021 Germany, USA, Taiwan Multicenter retrospective cohort 130 P1 ( n = 62), distal to P1 ( n = 68) 23 70 (±13.3) 14/9 9 (1–20) a 5 (22%) Mechanical thrombectomy 107 74 (±13.1) 56/51 7 (1–38) a 44 (41%) Meyer et al.…”

“…Another recent similar meta-analysis on this subject also found no differences in favorable 3‑month outcome, 3‑month mortality or sICH [ 26 ]. This meta-analysis had different search criteria, did not include six relevant studies which we identified in our search [ 9 , 11 , 14 , 17 , 21 , 22 ], therefore including only 338 iPCA patients who underwent EVT (compared to 461 patients in our study), and did not report relevant outcomes such as excellent 3‑month outcome, NIHSS change or improvement of visual field defects. This meta-analysis [ 26 ] performed comparisons of EVT versus best medical treatment in the same four studies but used the non-matched patient population of one of the studies [ 16 ], which is a potential source of relevant bias.…”

Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis

“…4,5 Unilateral CN III palsy is an atypical presentation of P1 segment thrombosis. 5 Usually, patients with P1 ischemic stroke present with hemiparesis, sensory loss, and visual problems, 6,7 as P1 perforating branches supply cerebral peduncles, tegmentum, and geniculate bodies, colliculi, and pulvinar of thalamus. 8 Blood supplies of the proximal part of the third cranial nerve could explain CN III palsy following an isolated P1 segment.…”