Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site.

Humans Female Male Aged Endovascular Procedures / methods Retrospective Studies Middle Aged Aged, 80 and over Infarction, Posterior Cerebral Artery / diagnostic imaging Treatment Outcome Case-Control Studies Severity of Illness Index Ischemic Stroke / therapy Thrombolytic Therapy / methods Stroke / therapy
case-control studies functional status posterior cerebral artery stroke thrombectomy

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
Jul 2024
Historique:
medline: 24 6 2024
pubmed: 16 5 2024
entrez: 16 5 2024
Statut: ppublish

Résumé

Acute ischemic stroke with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO acute ischemic stroke is modified by initial stroke severity (baseline National Institutes of Health Stroke Scale [NIHSS]) and arterial occlusion site. Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0-1), functional independence (mRS score 0-2), symptomatic intracranial hemorrhage, and mortality. From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution ( Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.

Sections du résumé

BACKGROUND UNASSIGNED
Acute ischemic stroke with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO acute ischemic stroke is modified by initial stroke severity (baseline National Institutes of Health Stroke Scale [NIHSS]) and arterial occlusion site.
METHODS UNASSIGNED
Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0-1), functional independence (mRS score 0-2), symptomatic intracranial hemorrhage, and mortality.
RESULTS UNASSIGNED
From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution (
CONCLUSIONS UNASSIGNED
Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.

Identifiants

DOI: 10.1161/STROKEAHA.124.047383 PMID: 38753954
pubmed: 38753954
doi: 10.1161/STROKEAHA.124.047383
doi:

Types de publication

Journal Article Multicenter Study Comparative Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

1787-1797

Auteurs

Davide Strambo (D)

Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Switzerland (D. Strambo, P.M.).
ORCID: 0000-0003-4429-2714

Patrik Michel (P)

Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Switzerland (D. Strambo, P.M.).
ORCID: 0000-0003-4954-7579

Thanh N Nguyen (TN)

Neurology (T.N.N., J.C.), Boston Medical Center, MA.
Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.
ORCID: 0000-0002-2810-1685

Mohamad Abdalkader (M)

Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.
ORCID: 0000-0002-9528-301X

Muhammad M Qureshi (MM)

Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.
Radiation Oncology (M.M.Q.), Boston Medical Center, MA.
ORCID: 0000-0002-2056-3308

Daniel Strbian (D)

Neurology (D. Strbian, S.R.), Helsinki University Hospital, University of Helsinki, Finland.
ORCID: 0000-0001-9095-2344

Christian Herweh (C)

Neuroradiology (C.H., M.A.M., J.J.), Heidelberg University Hospital, Germany.
ORCID: 0000-0002-9223-9662

Markus A Möhlenbruch (MA)

Neuroradiology (C.H., M.A.M., J.J.), Heidelberg University Hospital, Germany.

Silja Räty (S)

Neurology (D. Strbian, S.R.), Helsinki University Hospital, University of Helsinki, Finland.
ORCID: 0000-0002-6921-0597

Marta Olivé-Gadea (M)

Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Ribo, M. Requena).

Marc Ribo (M)

Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Ribo, M. Requena).

Marios Psychogios (M)

Radiology, Basel University Hospital, University of Basel, Switzerland (M.P., A.N.).

Urs Fischer (U)

Department of Neurology, University Hospital and University of Bern, Switzerland (U.F.).
Department of Neurology, University Hospital and University of Basel, Switzerland (U.F.).

Anh Nguyen (A)

Radiology, Basel University Hospital, University of Basel, Switzerland (M.P., A.N.).

Joji B Kuramatsu (JB)

Neurology (J.B.K, D.H.), University of Erlangen-Nuremberg, Germany.

David Haupenthal (D)

Neurology (J.B.K, D.H.), University of Erlangen-Nuremberg, Germany.

Martin Köhrmann (M)

Neurology, Institute of Diagnostic and Interventional Radiology (M. Köhrmann, J.K.E.), University Hospital Essen, Germany.

Cornelius Deuschl (C)

Neuroradiology (C.D.), University Hospital Essen, Germany.

Jordi Kühne Escolà (J)

Neurology, Institute of Diagnostic and Interventional Radiology (M. Köhrmann, J.K.E.), University Hospital Essen, Germany.

Jelle Demeestere (J)

Neurology, UZ Leuven, Belgium (J.D., R. Lemmens, L.V.).
Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R. Lemmens, L.V.).

Robin Lemmens (R)

Neurology, UZ Leuven, Belgium (J.D., R. Lemmens, L.V.).
Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R. Lemmens, L.V.).

Lieselotte Vandewalle (L)

Neurology, UZ Leuven, Belgium (J.D., R. Lemmens, L.V.).
Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R. Lemmens, L.V.).

Shadi Yaghi (S)

Neurology, Rhode Island Hospital (S.Y., L.S.).

Liqi Shu (L)

Neurology, Rhode Island Hospital (S.Y., L.S.).

Volker Puetz (V)

Neurology (V.P.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
Dresden University Stroke Center (V.P., D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

Daniel P O Kaiser (DPO)

Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
Dresden University Stroke Center (V.P., D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

Johannes Kaesmacher (J)

Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J.K., A. Mujanovic, B.S.).

Adnan Mujanovic (A)

Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J.K., A. Mujanovic, B.S.).

Dominique Cornelius Marterstock (DC)

Neuroradiology (D.C.M., T.E.), University of Erlangen-Nuremberg, Germany.

Tobias Engelhorn (T)

Neuroradiology (D.C.M., T.E.), University of Erlangen-Nuremberg, Germany.

Manuel Requena (M)

Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

Hormuzdiyar H Dasenbrock (HH)

Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.

Piers Klein (P)

Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.

Diogo C Haussen (DC)

Neurology, Grady Memorial Hospital (D.C.H., M.H.M., H.A., L.S.V.).

Mahmoud H Mohammaden (MH)

Neurology, Grady Memorial Hospital (D.C.H., M.H.M., H.A., L.S.V.).

Hend Abdelhamid (H)

Neurology, Grady Memorial Hospital (D.C.H., M.H.M., H.A., L.S.V.).

Lorena Souza Viana (L)

Neurology, Grady Memorial Hospital (D.C.H., M.H.M., H.A., L.S.V.).

Bruno Cunha (B)

Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.).

Isabel Fragata (I)

Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.).
NOVA Medical School, Universidade Nova de Lisboa, Portugal (I.F.).

Michele Romoli (M)

Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli).

Francesco Diana (F)

Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy (F.D.).

Wei Hu (W)

Neurology, The First Affiliated Hospital of USTC, Hefei, China (W.H., C.Z.).

Chao Zhang (C)

Neurology, The First Affiliated Hospital of USTC, Hefei, China (W.H., C.Z.).

Pekka Virtanen (P)

Radiology (P.V., R. Lauha, K.L.), Helsinki University Hospital, University of Helsinki, Finland.

Riikka Lauha (R)

Radiology (P.V., R. Lauha, K.L.), Helsinki University Hospital, University of Helsinki, Finland.

Jessica Jesser (J)

Neuroradiology (C.H., M.A.M., J.J.), Heidelberg University Hospital, Germany.

Judith Clark (J)

Neurology (T.N.N., J.C.), Boston Medical Center, MA.

Stavros Matsoukas (S)

Neurosurgery, Mount Sinai Health System (S.M., J.T.F.).

Johanna T Fifi (JT)

Neurosurgery, Mount Sinai Health System (S.M., J.T.F.).

Sunil A Sheth (SA)

Neurology, McGovern Medical School at UTHealth, TX (S.A.S., S.S.-M.).

Sergio Salazar-Marioni (S)

Neurology, McGovern Medical School at UTHealth, TX (S.A.S., S.S.-M.).

João Pedro Marto (JP)

Neurology (J.P.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.

João Nuno Ramos (JN)

Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal.

Milena Miszczuk (M)

Neuroradiology (M. Miszczuk, E.S.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

Christoph Riegler (C)

Departement of Neurology and Experimental Neurology, and Center for Stroke Research Berlin (C.R., C.H.N.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

Sven Poli (S)

Department of Neurology and Stroke (S.P., K.P.), University of Tübingen, Germany.
Hertie Institute for Clinical Brain Research (S.P., K.P.), University of Tübingen, Germany.

Khouloud Poli (K)

Department of Neurology and Stroke (S.P., K.P.), University of Tübingen, Germany.
Hertie Institute for Clinical Brain Research (S.P., K.P.), University of Tübingen, Germany.

Ashutosh P Jadhav (AP)

Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.).

Shashvat M Desai (SM)

Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.).

Volker Maus (V)

Radiology, Neuroradiology, and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M.K.).
Institute of Radiology and Neuroradiology, Klinikum Aschaffenburg, Germany (V.M.).

Maximilian Kaeder (M)

Radiology, Neuroradiology, and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M.K.).

Adnan H Siddiqui (AH)

Radiology (T.N.N., M.A., M.M.Q., P.K., H.D.), Boston Medical Center, MA.

Andre Monteiro (A)

Neurosurgery, University of Buffalo, NY (A.H.S., A. Monteiro).

Hesham E Masoud (HE)

Neurology, New York Upstate Medical University (H.E.M.).

Neil Suryadareva (N)

Neurology, University of Pittsburgh Medical Center, PA (N.S., R.G.N.).

Maxim Mokin (M)

Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.).

Shail Thanki (S)

Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.).

Kemal Alpay (K)

Radiology (K.A.), Turku University Hospital, Finland.

Pauli Ylikotila (P)

Neurology (P.Y.), Turku University Hospital, Finland.

James E Siegler (JE)

Neurology, University of Chicago, IL (J.E.S.).

Italo Linfante (I)

Miami Neuroscience Institute, FL (I.L., G.D.).

Guilherme Dabus (G)

Miami Neuroscience Institute, FL (I.L., G.D.).

Negar Asdaghi (N)

Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.).

Vasu Saini (V)

Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.).

Christian H Nolte (CH)

Departement of Neurology and Experimental Neurology, and Center for Stroke Research Berlin (C.R., C.H.N.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

Eberhard Siebert (E)

Neuroradiology (M. Miszczuk, E.S.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.

Bettina L Serrallach (BL)

Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J.K., A. Mujanovic, B.S.).

Charlotte S Weyland (CS)

Neuroradiology, University Hospital RWTH Aachen, Germany (C.S.W.).

Uta Hanning (U)

Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.).

Lukas Meyer (L)

Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.).

Anne Berberich (A)

Neurology, Klinikum Ludwigshafen, Germany (A.B., S.N.).

Peter A Ringleb (PA)

Neurology (P.A.R., S.N.), Heidelberg University Hospital, Germany.

Raul G Nogueira (RG)

Neurology, University of Pittsburgh Medical Center, PA (N.S., R.G.N.).

Simon Nagel (S)

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Endovascular Versus Medical Therapy in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Endovascular Versus Medical Therapy in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Endovascular Versus Medical Therapy in...
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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Endovascular Versus Medical Therapy in...
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