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.
distal vessel occlusion
endovascular therapy
intravenous thrombolysis
posterior cerebral artery occlusion
stroke
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
08
05
2022
received:
20
04
2022
accepted:
09
05
2022
pubmed:
20
5
2022
medline:
9
8
2022
entrez:
19
5
2022
Statut:
ppublish
Résumé
Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study-level meta-analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0-2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Twelve studies with a total of 679 patients were included in the meta-analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83-70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35-55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30-20.93) and 12.3% (95% CI 8.64-17.33). sICH occurred in 4.2% (95% CI 2.47-7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75-5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.
Sections du résumé
BACKGROUND AND PURPOSE
Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study-level meta-analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke.
METHODS
We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0-2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH).
RESULTS
Twelve studies with a total of 679 patients were included in the meta-analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83-70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35-55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30-20.93) and 12.3% (95% CI 8.64-17.33). sICH occurred in 4.2% (95% CI 2.47-7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75-5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences.
CONCLUSIONS
Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2664-2673Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Ntaios G, Spengos K, Vemmou AM, et al. Long-term outcome in posterior cerebral artery stroke. Eur J Neurol. 2011;18(8):1074-1080.
Cereda C, Carrera E. Posterior cerebral artery territory infarctions. Front Neurol Neurosci. 2012;30:128-131.
Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR. Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. Cerebrovasc Dis. 2000;10(3):170-182.
Ng YS, Stein J, Salles SS, Black-Schaffer RM. Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke. Arch Phys Med Rehabil. 2005;86(11):2138-2143.
Strambo D, Bartolini B, Beaud V, et al. Thrombectomy and thrombolysis of isolated posterior cerebral artery occlusion: cognitive, visual, and disability outcomes. Stroke. 2020;51(1):254-261.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.
Eskey CJ, Meyers PM, Nguyen TN, et al. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association. Circulation. 2018;137(21):e661-e689.
Saver JL, Chapot R, Agid R, et al. Thrombectomy for distal, medium vessel occlusions: a consensus statement on present knowledge and promising directions. Stroke. 2020;51(9):2872-2884.
Perez-Garcia C, Moreu M, Rosati S, et al. Mechanical thrombectomy in medium vessel occlusions: blind exchange with mini-pinning technique versus mini stent retriever alone. Stroke. 2020;51(11):3224-3231.
Puetz V, Strbian D, Nguyen TN, Nagel S. Editorial: challenges in posterior circulation ischemic stroke. Front Neurol. 2021;12:789836.
Abdalkader MSA, Dmytriw AA, Brinjikji W, Dabus G, Raz E, et al. Mechanical thrombectomy of the fetal posterior cerebral artery. Stroke: vascular and interventional. Neurology. 2021;2021(1):e000115.
Herweh C, Abdalkader M, Nguyen TN, et al. Mechanical thrombectomy in isolated occlusion of the proximal posterior cerebral artery. Front Neurol. 2021;12:697348.
Meyer L, Stracke CP, Jungi N, et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the TOPMOST study. JAMA Neurol. 2021;78(4):434-444.
Memon MZ, Kushnirsky M, Brunet MC, Saini V, Koch S, Yavagal DR. Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions. Neuroradiology. 2021;63(1):111-116.
Nogueira RG, Mohammaden MH, Haussen DC, et al. Endovascular therapy in the distal neurovascular territory: results of a large prospective registry. J Neurointerv Surg. 2021;13(11):979-984.
Baik SH, Jung C, Kim BM, Kim DJ. Mechanical thrombectomy for acute posterior cerebral artery stroke; feasibility and predictors of outcome. Neuroradiology. 2022;64(7):1419-1427. doi:10.1007/s00234-022-02910-3
Monteiro A, Khan S, Waqas M, et al. Mechanical thrombectomy versus intravenous alteplase alone in acute isolated posterior cerebral artery occlusion: a systematic review. J Neurointerv Surg. 2021;14:564-567.
Baig AA, Monteiro A, Waqas M, et al. Acute isolated posterior cerebral artery stroke treated with mechanical thrombectomy: a single-center experience and review of the literature. Interv Neuroradiol. 2022;15910199211070949. doi:10.1177/15910199211070949. Online ahead of print.
Cunha B, Baptista M, Pamplona J, et al. Acute treatment of isolated posterior cerebral artery occlusion: single center experience. J Stroke Cerebrovasc Dis. 2022;31(2):106239.
Miszczuk M, Bauknecht HC, Kleine JF, et al. Mechanical thrombectomy of acute distal posterior cerebral artery occlusions. J Clin Neurosci. 2021;88:57-62.
Brouwer J, Ergezen S, Mulder M, et al. Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry. J Neurointerv Surg. 2022;neurintsurg-2021-018505. doi:10.1136/neurintsurg-2021-018505. Online ahead of print.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators. Lancet. 1998;352(9136):1245-1251.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-1329.
Meier N, Fischer U, Schroth G, et al. Outcome after thrombolysis for acute isolated posterior cerebral artery occlusion. Cerebrovasc Dis. 2011;32(1):79-88.
Breuer L, Huttner HB, Jentsch K, et al. Intravenous thrombolysis in posterior cerebral artery infarctions. Cerebrovasc Dis. 2011;31(5):448-454.
von Kummer R, Broderick JP, Campbell BC, et al. The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke. 2015;46(10):2981-2986.
Higgins JP, Altman DG, Gotzsche PC, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Forster A, Gass A, Kern R, Wolf ME, Hennerici MG, Szabo K. MR imaging-guided intravenous thrombolysis in posterior cerebral artery stroke. AJNR Am J Neuroradiol. 2011;32(2):419-421.
Mistry EA, Yeatts S, de Havenon A, et al. Predicting 90-day outcome after thrombectomy: baseline-adjusted 24-hour NIHSS is more powerful than NIHSS score change. Stroke. 2021;52(8):2547-2553.
Campbell BCV, Nguyen TN. Advances in stroke: treatments-interventional. Stroke. 2022;53(1):264-267.