Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

被引：65

作者：

Nguyen, Thanh N. ^{[1
,2
]}

Qureshi, Muhammad M. ^{[2
,3
]}

Strambo, Davide ^{[4
]}

Strbian, Daniel ^{[5
]}

Raety, Silja ^{[5
]}

Herweh, Christian ^{[7
]}

Abdalkader, Mohamad ^{[2
]}

Olive-Gadea, Marta ^{[9
]}

Ribo, Marc ^{[9
]}

Psychogios, Marios ^{[11
]}

Fischer, Urs ^{[12
,41
]}

Nguyen, Anh ^{[11
]}

Kuramatsu, Joji B. ^{[13
]}

Haupenthal, David ^{[13
,21
]}

Koehrmann, Martin ^{[15
]}

Deuschl, Cornelius ^{[16
]}

Escola, Jordi Kuehne ^{[15
]}

Yaghi, Shadi ^{[17
]}

Shu, Liqi ^{[17
]}

Puetz, Volker ^{[18
]}

Kaiser, Daniel P. O. ^{[19
]}

Kaesmacher, Johannes ^{[20
]}

Mujanovic, Adnan ^{[20
]}

Marterstock, Dominique Cornelius ^{[14
]}

Engelhorn, Tobias ^{[14
]}

Klein, Piers ^{[2
]}

Haussen, Diogo C.

Mohammaden, Mahmoud H. ^{[21
]}

Abdelhamid, Hend ^{[21
]}

Viana, Lorena Souza ^{[21
]}

Cunha, Bruno ^{[22
]}

Fragata, Isabel ^{[22
]}

Romoli, Michele ^{[23
]}

Diana, Francesco ^{[10
]}

Virtanen, Pekka ^{[6
,24
]}

Lappalainen, Kimmo ^{[6
,24
]}

Clark, Judith ^{[1
]}

Matsoukas, Stavros ^{[25
]}

Fifi, Johanna T. ^{[25
]}

Sheth, Sunil A. ^{[26
]}

Salazar-Marioni, Sergio ^{[26
]}

Marto, Joao Pedro ^{[27
]}

Ramos, Joao Nuno ^{[28
]}

Miszczuk, Milena ^{[29
]}

Riegler, Christoph ^{[30
,31
,32
]}

Jadhav, Ashutosh P. ^{[33
]}

Desai, Shashvat M. ^{[33
]}

Maus, Volker ^{[34
]}

Kaeder, Maximilian ^{[34
]}

Siddiqui, Adnan H. ^{[35
]}

机构：

[1] Boston Med Ctr, Neurol, Boston, MA USA

[2] Boston Med Ctr, Radiol, Boston, MA USA

[3] Boston Med Ctr, Radiat Oncol, Boston, MA USA

[4] Univ Lausanne, Lausanne Univ Hosp, Neurol Serv, Lausanne, Switzerland

[5] Helsinki Univ Hosp, Neurol, Helsinki, Finland

[6] Helsinki Univ Hosp, Radiol, Helsinki, Finland

[7] Heidelberg Univ Hosp, Neuroradiol, Heidelberg, Germany

[8] Heidelberg Univ Hosp, Neurol, Heidelberg, Germany

[9] Hosp Univ Vall dHebron, Neurol, Barcelona, Spain

[10] Hosp Univ Vall dHebron, Intervent Neuroradiol, Barcelona, Spain

[11] Univ Basel, Basel Univ Hosp, Radiol, Basel, Switzerland

[12] Univ Basel, Basel Univ Hosp, Neurol, Basel, Switzerland

[13] Univ Erlangen Nurnberg, Neurol, Nurnberg, Germany

[14] Univ Erlangen Nurnberg, Neuroradiol, Nurnberg, Germany

[15] Univ Klinikum Essen, Neurol, Essen, Germany

[16] Univ Klinikum Essen, Radiol, Essen, Germany

[17] Brown Univ, Rhode Isl Hosp, Med Sch, Neurol, Providence, RI USA

[18] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Neurol, Dresden, Germany

[19] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Neuroradiol, Dresden, Germany

[20] Univ Bern, Univ Hosp Bern, Inst Diagnost & Intervent Neuroradiol, Inselspital, Bern, Switzerland

[21] Grady Mem Hosp, Neurol, Atlanta, GA USA

[22] Ctr Hosp Univ Lisboa Cent, Neuroradiol, Lisbon, Portugal

[23] Bufalini Hosp, Dept Neurosci, Neurol & Stroke Unit, Cesena, Italy

[24] Univ Helsinki, Helsinki Univ Hosp, Radiol, Helsinki, Finland

[25] Mt Sinai Hlth Syst, Neurosurg, New York, NY USA

[26] UTHealth, Neurol, McGovern Med Sch, Houston, TX USA

[27] Ctr Hosp Lisboa Ocidental, Hosp Egas Moniz, Neurol, Lisbon, Portugal

[28] Ctr Hosp Lisboa Ocidental, Hosp Egas Moniz, Neuroradiol, Lisbon, Portugal

[29] Free Univ Berlin, Neuroradiol, Berlin, Germany

[30] Free Univ Berlin, Neurol Expt Neurol, Berlin, Germany

[31] Humboldt Univ, Berlin, Germany

[32] Charite, Berlin, Germany

[33] Barrow Neurol Inst, Neurosurg, Phoenix, AZ USA

[34] Univ Hosp Knappschaftskrankenhaus Bochum, Radiol Neuroradiol & Nucl Med, Bochum, Germany

[35] Univ Buffalo, Neurosurg, Buffalo, NY USA

[36] New York Upstate Med Univ, Neurol, Syracuse, NY USA

[37] Univ S Florida, Neurosurg, Tampa, FL USA

[38] Cooper Neurol Inst, Camden, NJ USA

[39] Univ Miami, Miami Neurosci Inst, Miami, FL USA

[40] Univ Miami, Neurol, Miller Sch Med, Miami, FL USA

[41] Univ Bern, Bern Univ Hosp, Neurol, Bern, Switzerland

[42] Aristotle Univ Thessaloniki, Radiol, Thessaloniki, Greece

[43] Univ Med Ctr Hamburg Eppendorf, Diagnost & Intervent Neuroradiol, Hamburg, Germany

[44] Univ Pittsburgh, Neurol, Med Ctr, Pittsburgh, PA USA

[45] Klinikum Ludwigshafen, Neurol, Ludwigshafen, Germany

来源：

STROKE | 2023年 / 54卷 / 07期

关键词：

case-control studies; cerebrovascular disorders; logistic models; posterior cerebral artery; stroke; thrombectomy; thrombolytic therapy;

D O I：

10.1161/STROKEAHA.123.042674

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background:The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods:This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and & GE;2-point decrease in the National Institutes of Health Stroke Scale. Results:Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by & GE;2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions:In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

引用

页码：1708 / 1717

页数：10

共 15 条

[1]

Abdalkader M., 2021, STROKE VASC INT NEUR, V1, pe000115

[2] Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials [J].

Abdalkader, Mohamad ;

Finitsis, Stephanos ;

Li, Chuanhui ;

Hu, Wei ;

Liu, Xinfeng ;

Ji, Xunming ;

Huo, Xiaochuan ;

Alemseged, Fana ;

Qiu, Zhongming ;

Strbian, Daniel ;

Puetz, Volker ;

Siegler, James E. ;

Yaghi, Shadi ;

Asif, Kaiz ;

Klein, Piers ;

Zhu, Yuyou ;

Campbell, Bruce C. V. ;

Chen, Hui-Sheng ;

Nagel, Simon ;

Tsivgoulis, Georgios ;

Miao, Zhongrong ;

Nogueira, Raul G. ;

Jovin, Tudor G. ;

Schonewille, Wouter J. ;

Nguyen, Thanh N. .

JOURNAL OF STROKE, 2023, 25 (01) :81-91

[3] Endovascular Therapy for Basilar Artery Occlusion [J].

Alemseged, Fana ;

Nguyen, Thanh N. ;

Alverne, Francisco Mont' ;

Liu, Xinfeng ;

Schonewille, Wouter J. ;

Nogueira, Raul G. .

STROKE, 2023, 54 (04) :1127-1137

[4] Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies [J].

Austin, Peter C. ;

Stuart, Elizabeth A. .

STATISTICS IN MEDICINE, 2015, 34 (28) :3661-3679

[5] Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta-analysis [J].

Berberich, Anne ;

Finitsis, Stephanos ;

Strambo, Davide ;

Michel, Patrik ;

Herweh, Christian ;

Meyer, Lukas ;

Hanning, Uta ;

Strbian, Daniel ;

Abdalkader, Mohamad ;

Nogueira, Raul G. ;

Puetz, Volker ;

Kaiser, Daniel P. O. ;

Olive-Gadea, Marta ;

Ribo, Marc ;

Fragata, Isabel ;

Marto, Joao Pedro ;

Romoli, Michele ;

Ringleb, Peter A. ;

Nguyen, Thanh N. ;

Nagel, Simon .

EUROPEAN JOURNAL OF NEUROLOGY, 2022, 29 (09) :2664-2673

[6] Patients may be right: Clinical research should be designed in their best medical interest [J].

Darsaut, T. E. ;

Collins, J. ;

Raymond, J. .

NEUROCHIRURGIE, 2023, 69 (01)

[7] Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion A Population-Based Study (Dijon Stroke Registry) [J].

Duloquin, Gauthier ;

Graber, Mathilde ;

Garnier, Lucie ;

Crespy, Valentin ;

Comby, Pierre-Olivier ;

Baptiste, Laura ;

Mohr, Sophie ;

Delpont, Benoit ;

Gueniat, Julien ;

Blanc-Labarre, Christelle ;

Hervieu-Begue, Marie ;

Osseby, Guy-Victor ;

Giroud, Maurice ;

Bejot, Yannick .

STROKE, 2020, 51 (07) :2122-2130

[8] The Society of Vascular and Interventional Neurology (SVIN) Mechanical Thrombectomy Registry: Methods and Primary Results [J].

Haussen, Diogo C. ;

Al-Bayati, Alhamza R. ;

Mohammaden, Mahmoud H. ;

Sheth, Sunil A. ;

Salazar-Marioni, Sergio ;

Linfante, Italo ;

Dabus, Guilherme ;

Starosciak, Amy K. ;

Hassan, Ameer E. ;

Tekle, Wondwossen G. ;

Nguyen, Thanh N. ;

Abdalkader, Mohamad ;

Klein, Piers ;

Siegler, James E. ;

Patel, Pratit D. ;

Jovin, Tudor G. ;

Ortega-Gutierrez, Santiago ;

Farooqui, Mudassir ;

Zevallos, Cynthia ;

Majidi, Shahram ;

Fifi, Johanna T. ;

Matsoukas, Stavros ;

Mehta, Brijesh P. ;

Sessa, Joy E. ;

Sugg, Rebecca M. ;

Cordina, Steve ;

Linares, Guillermo ;

Gordon, Weston R. ;

Jumaa, Mouhammad A. ;

Liebeskind, David S. ;

Nogueira, Raul G. .

STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY, 2022, 2 (02)

[9] Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery [J].

Herweh, Christian ;

Abdalkader, Mohamad ;

Nguyen, Thanh N. ;

Puetz, Volker ;

Schoene, Daniela ;

Kaiser, Daniel ;

Chen, Chih-Hao ;

Jeng, Jiann-Shing ;

Moehlenbruch, Markus A. ;

Ringleb, Peter A. ;

Nagel, Simon .

FRONTIERS IN NEUROLOGY, 2021, 12

[10] Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke The TOPMOST Study [J].

Meyer, Lukas ;

Stracke, Christian Paul ;

Jungi, Noel ;

Wallocha, Marta ;

Broocks, Gabriel ;

Sporns, Peter B. ;

Maegerlein, Christian ;

Dorn, Franziska ;

Zimmermann, Hanna ;

Naziri, Weis ;

Abdullayev, Nuran ;

Kabbasch, Christoph ;

Behme, Daniel ;

Jamous, Ala ;

Maus, Volker ;

Fischer, Sebastian ;

Moehlenbruch, Markus ;

Weyland, Charlotte Sabine ;

Langner, Soenke ;

Meila, Dan ;

Miszczuk, Milena ;

Siebert, Eberhard ;

Lowens, Stephan ;

Krause, Lars Udo ;

Yeo, Leonard L. L. ;

Tan, Benjamin Yong-Qiang ;

Anil, Gopinathan ;

Gory, Benjamin ;

Galvan, Jorge ;

Arteaga, Miguel Schueller ;

Navia, Pedro ;

Raz, Eytan ;

Shapiro, Maksim ;

Arnberg, Fabian ;

Zelenak, Kamil ;

Martinez-Galdamez, Mario ;

Fischer, Urs ;

Kastrup, Andreas ;

Roth, Christian ;

Papanagiotou, Panagiotis ;

Kemmling, Andre ;

Gralla, Jan ;

Psychogios, Marios-Nikos ;

Andersson, Tommy ;

Chapot, Rene ;

Fiehler, Jens ;

Kaesmacher, Johannes ;

Hanning, Uta .

JAMA NEUROLOGY, 2021, 78 (04) :434-444

← 1 2 →