@article{3102601,
    title = "Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study",
    author = "Meyer, L. and Stracke, C.P. and Jungi, N. and Wallocha, M. and Broocks, G. and Sporns, P.B. and Maegerlein, C. and Dorn, F. and Zimmermann, H. and Naziri, W. and Abdullayev, N. and Kabbasch, C. and Behme, D. and Jamous, A. and Maus, V. and Fischer, S. and Möhlenbruch, M. and Weyland, C.S. and Langner, S. and Meila, D. and Miszczuk, M. and Siebert, E. and Lowens, S. and Krause, L.U. and Yeo, L.L.L. and Tan, B.Y.-Q. and Anil, G. and Gory, B. and Galván, J. and Arteaga, M.S. and Navia, P. and Raz, E. and Shapiro, M. and Arnberg, F. and Zeleňák, K. and Martinez-Galdamez, M. and Fischer, U. and Kastrup, A. and Roth, C. and Papanagiotou, P. and Kemmling, A. and Gralla, J. and Psychogios, M.-N. and Andersson, T. and Chapot, R. and Fiehler, J. and Kaesmacher, J. and Hanning, U.",
    journal = "JAMA Neurology",
    year = "2021",
    volume = "78",
    number = "4",
    pages = "434-444",
    publisher = "American Medical Association",
    issn = "2168-6149, 2168-6157",
    doi = "10.1001/jamaneurol.2021.0001",
    keywords = "fibrinolytic agent, adult;  age;  aged;  Article;  Asia;  blood clot lysis;  brain hemorrhage;  brain ischemia;  case control study;  clinical practice;  cohort analysis;  computed tomographic angiography;  computer assisted tomography;  controlled study;  Europe;  female;  follow up;  health care facility;  hospital discharge;  human;  intermethod comparison;  major clinical study;  male;  mechanical thrombectomy;  medical decision making;  middle aged;  mortality;  National Institutes of Health Stroke Scale;  nuclear magnetic resonance imaging;  occlusive cerebrovascular disease;  outcome assessment;  patient safety;  posterior cerebral artery;  priority journal;  propensity score;  Rankin scale;  retrospective study;  treatment outcome;  United States;  very elderly;  brain ischemia;  cerebrovascular accident;  cerebrovascular disease;  clinical trial;  diagnostic imaging;  fibrinolytic therapy;  intravenous drug administration;  multicenter study;  posterior cerebral artery;  procedures;  thrombectomy, Administration, Intravenous;  Aged;  Aged, 80 and over;  Brain Ischemia;  Case-Control Studies;  Cerebrovascular Disorders;  Female;  Follow-Up Studies;  Humans;  Male;  Middle Aged;  Posterior Cerebral Artery;  Retrospective Studies;  Stroke;  Thrombectomy;  Thrombolytic Therapy",
    abstract = "Importance: Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective: To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Design, Setting, and Participants: This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Interventions: Mechanical thrombectomy or standard medical treatment with or without IVT. Main Outcomes and Measures: Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Results: Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P =.06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P =.04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P =.005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. Conclusions and Relevance: This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.. © 2021 American Medical Association. All rights reserved."
}