Τίτλος:
Feasibility and safety of thrombectomy for isolated occlusions of the posterior cerebral artery: A multicenter experience and systematic literature review
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background Substantial clinical evidence supporting the benefit of mechanical thrombectomy (MT) for distal occlusions within the posterior circulation is still missing. This study aims to investigate the procedural feasibility and safety of MT for isolated occlusions of the posterior cerebral artery. Methods We retrospectively reviewed patients from three stroke centers with acute ischemic stroke attributed to isolated posterior cerebral artery occlusion (IPCAOs) who underwent MT between January 2014 and December 2019. Procedural and safety assessment included successful recanalization rates (defined as Thrombolysis in Cerebral Infarction Scale (TICI) ≥2b), number of MT attempts and first-pass effect (TICI 3), intracranial hemorrhage (ICH), mortality, and intervention-related serious adverse events. Treatment effects were evaluated by the rate of early neurological improvement (ENI) and early functional outcome was assessed with the modified Rankin Scale (mRS) at discharge. A systematic literature review was conducted to identify and summarize previous reports on MT for IPCAOs. Results Forty-three patients with IPCAOs located in the P1 (55.8%, 24/43), P2 (37.2%, 16/43), and P3 segment (7%, 3/43) were analyzed. The overall rate of successful recanalization (TICI ≥2b) was 86% (37/43), including a first pass-effect of 48.8% (21/43) leading to TICI 3. sICH occurred in 7% (3/43) and there were two cases with iatrogenic vessel dissection and one perforation. ENI was observed in 59% (23/39) and excellent functional outcome (mRS ≤1) in 46.2% (18/39) of patients who were discharged. The in-hospital mortality rate was 9.3% (4/43). Conclusion Our study suggests the technical feasibility and safety of thrombectomy for IPCAOs. Further studies are needed to investigate safety and long-term functional outcomes with posterior circulation stroke-adjusted outcome assessment. © 2021 BMJ Publishing Group. All rights reserved.
Συγγραφείς:
Meyer, L.
Papanagiotou, P.
Politi, M.
Kastrup, A.
Kraemer, C.
Hanning, U.
Kniep, H.
Broocks, G.
Pilgram-Pastor, S.M.
Wallocha, M.
Chapot, R.
Fiehler, J.
Stracke, C.P.
Leischner, H.
Περιοδικό:
Journal of Neurointerventional Surgery
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
artery dissection; blood vessel perforation; brain hemorrhage; brain ischemia; first pass effect; hospital discharge; hospital mortality; human; mechanical thrombectomy; mortality rate; multicenter study (topic); occlusive cerebrovascular disease; patient safety; patient selection; posterior cerebral artery occlusion; postoperative complication; priority journal; Rankin scale; recanalization; Review; risk assessment; scoring system; systematic review; therapy effect; Thrombolysis in Cerebral Infarction Scale; treatment outcome; adverse event; aged; cerebrovascular disease; clinical trial; feasibility study; female; male; middle aged; mortality; multicenter study; posterior cerebral artery; procedures; prospective study; retrospective study; thrombectomy; very elderly, Aged; Aged, 80 and over; Cerebrovascular Disorders; Feasibility Studies; Female; Hospital Mortality; Humans; Male; Middle Aged; Posterior Cerebral Artery; Prospective Studies; Retrospective Studies; Thrombectomy; Treatment Outcome
DOI:
10.1136/neurintsurg-2020-016059
