[en] [en] BACKGROUND: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown.
METHODS: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0-2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0-1), symptomatic intracranial hemorrhage, and early neurological deterioration.
RESULTS: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63-82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66-1.01]; P=0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95-1.43]; P=0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35-4.67]; P=0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64-3.84]; P<0.0001).
CONCLUSIONS: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.
Disciplines :
Neurology
Author, co-author :
Sabben, Candice ; Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France
Charbonneau, Frédérique ; Neuroradiology Department (F.C.), Rothschild Foundation Hospital, Paris, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology Department (F.D., M.M.), Rothschild Foundation Hospital, Paris, France
Strambo, Davide ; Stroke Center, Neurology Service (D.S., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland
Heldner, Mirjam R ; Department of Neurology, University Hospital and University of Bern, Switzerland (M.R.H
Ong, Elodie; Stroke Department, Hospices Civils de Lyon, France (E.O
Ter Schiphorst, Adrien; Neurology Department, CHRU Gui de Chauliac, Montpellier, France (A.T.S
Henon, Hilde ; Neurology department, Stroke Center, University of Lille, Inserm U1171, CHU Lille, LilNCog - Lille Neuroscience & Cognition, France (H.H
Ben Hassen, Wagih ; Neuroradiology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (W.B.H
Agasse-Lafont, Thomas ; Neurology Department, CHU Rennes, France (T.A.-L
Legris, Loïc ; Neurology Department, Stroke Unit, Grenoble Alpes University Hospital, University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France (L.L
Sibon, Igor ; Stroke Unit, Bordeaux University Hospital, France (I.S
Wolff, Valérie; Stroke Unit, Strasbourg University Hospital, France (V.W
Sablot, Denis ; Neurology Department, CH Perpignan, France (D.S
Preterre, Cécile; Neurology Department, CHU Nantes, France (C.P
Nehme, Nour; Neurology Department, André Mignot Hospital, Versailles, France (N.N
Soize, Sébastien ; Neuroradiology Department, CHU Reims, France (S.S
Weisenburger-Lile, David; Neurology Department, Foch Hospital, Suresnes, France (D.W.-L
Triquenot-Bagan, Aude ; Neurology Department, Rouen University Hospital, F-76000, Rouen, France (A.T.-B
Mione, Gioia ; Neurology Department, University Hospital of Nancy, France (G.M
Aignatoaie, Andreea; Neurology Department, CHR Orléans, France (A.A
Papassin, Jérémie; Neurology Department, CH Metropole Savoie, Chambery, France (J.P
Poll, Roxana; Neurology Department, Rene Dubois Hospital, Pontoise, France (R.P
Béjot, Yannick ; Neurology Department, CHU Dijon, France (Y.B
Carrera, Emmanuel ; Neurology Department, Geneve University Hospital, Switzerland (E.C
Garnier, Pierre; Neurology Department, Stroke Unit, CHU St Etienne, France (P.G
Michel, Patrik ; Stroke Center, Neurology Service (D.S., P.M.), Lausanne University Hospital and University of Lausanne, Switzerland
Saliou, Guillaume ; Diagnostic and Interventional Radiology Department (G.S.), Lausanne University Hospital and University of Lausanne, Switzerland
Mordasini, Pasquale; Netzwerk Radiology, Kantonsspital St. Gallen, Switzerland (P.M
Berthezene, Yves; Neuroradiology Department, Hospices Civils de Lyon, France (Y.B
Costalat, Vincent; Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France (V.C
Bricout, Nicolas ; Interventional Neuroradiology Department, CHU Lille, France (N.B
Albers, Gregory W ; Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., P.S
Mazighi, Mikael ; Interventional Neuroradiology Department (F.D., M.M.), Rothschild Foundation Hospital, Paris, France ; Neurology Department, Lariboisière Hospital, APHP Nord, INSERM 1148, Université Paris Cité, Paris, France (M.M ; FHU Neurovasc (M.M., G.T
Turc, Guillaume ; FHU Neurovasc (M.M., G.T ; Neurology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France (G.T ; Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR_S1266, Université Paris Cité, France (G.T., P.S
Seners, Pierre ; Neurology Department (C.S., P.S.), Rothschild Foundation Hospital, Paris, France ; Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., P.S
Dr Heldner reports grants from Swiss National Science Foundation, Swiss Heart Foundation, Gottfried und Julia Bangerter-Rhyner-Stiftung, SITEM Research Funds, and Amgen. Dr Béjot reports compensation from Medtronic, Pfizer, Bristol-Myers Squibb, Servier, Boehringer Ingelheim, Amgen, and Novo Nordisk for other services; and employment by Dijon University hospital. Dr Michel reports grants from University of Lausanne, Swiss Heart Foundation, and Swiss National Science Foundation. Dr Bricout reports compensation from Qapel medical and Stryker for consultant services. Dr Albers reports stock holdings in iSchemaView; compensation from Biogen, iSchemaView, and Genentech for consultant services. Dr Mazighi reports compensation from Boerhinger-Ingelheim, Novo Nordisk, and Acticor biotech for consultant services. Dr Turc reports compensation from Guerbet France for other services. The other authors report no conflicts.
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