TY - JOUR
T1 - Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry
AU - Brouwer, Josje
AU - Ergezen, Saliha
AU - Mulder, Maxim J.H.L.
AU - Lycklama A. Nijeholt, Geert J.
AU - van Es, Adriaan C.G.M.
AU - van der Lugt, Aad
AU - Dippel, Diederik W.J.
AU - Majoie, Charles B.L.M.
AU - Roos, Yvo B.W.E.M.
AU - Coutinho, J.M.
AU - Emmer, Bart J.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Boiten, Jelis
AU - Vos, Jan Albert
AU - Jansen, Ivo G.H.
AU - Goldhoorn, Robert Jan B.
AU - Compagne, Kars C.J.
AU - Kappelhof, Manon
AU - den Hartog, Sanne J.
AU - Hinsenveld, Wouter H.
AU - Roozenbeek, Bob
AU - Schonewille, Wouter J.
AU - Wermer, Marieke J.H.
AU - van Walderveen, Marianne A.A.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - van der Worp, H. Bart
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - Boogaarts, Hieronymus D.
AU - de Vries, J.
AU - de Kort, Paul L.M.
AU - van Tuijl, Julia
AU - Peluso, Jo P.
AU - Fransen, Puck
AU - van den Berg, Jan S.P.
AU - van Hasselt, Boudewijn A.A.M.
AU - Aerden, Leo A.M.
AU - Dallinga, René J.
AU - Uyttenboogaart, Maarten
AU - Eschgi, Omid
AU - Keizer, Koos
AU - de Jong, Anouk
AU - Boers, Anna M.M.
AU - Groot, P.F.C.
AU - Voogd, Eva J.H.F.
AU - MR CLEAN Registry Investigators
N1 - Publisher Copyright:
© Author(s).
PY - 2023/5/18
Y1 - 2023/5/18
N2 - Background: Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit.Objective: To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (ΔNIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications.Results: Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred.Conclusions: EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
AB - Background: Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit.Objective: To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (ΔNIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications.Results: Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred.Conclusions: EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
KW - 2025 OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85135401661&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2021-018505
DO - 10.1136/neurintsurg-2021-018505
M3 - Article
C2 - 35292567
AN - SCOPUS:85135401661
SN - 1759-8478
VL - 15
SP - 363
EP - 369
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 4
ER -
