Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke.

Autor:	Räty S; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Nguyen TN; Department of Radiology, Boston Medical Center, Boston, MA, USA.; Department of Neurology, Boston Medical Center, Boston, MA, USA., Nagel S; Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany., Strambo D; Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Michel P; Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Herweh C; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany., Qureshi MM; Department of Radiology, Boston Medical Center, Boston, MA, USA., Abdalkader M; Department of Radiology, Boston Medical Center, Boston, MA, USA., Virtanen P; Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Olive-Gadea M; Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain., Ribo M; Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain., Psychogios M; Department of Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland., Nguyen A; Department of Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland., Kuramatsu JB; Department of Neurology, University of Erlangen, Erlangen, Germany., Haupenthal D; Department of Neurology, University of Erlangen, Erlangen, Germany., Köhrmann M; Department of Neurology, Universitätsklinikum Essen, Essen, Germany., Deuschl C; Department of Radiology, Universitätsklinikum Essen, Essen, Germany., Escolà JK; Department of Neurology, Universitätsklinikum Essen, Essen, Germany., Demeestere J; Department of Neurology, UZ Leuven, Leuven, Belgium., Lemmens R; Department of Neurology, UZ Leuven, Leuven, Belgium., Vandewalle L; Department of Neurology, UZ Leuven, Leuven, Belgium., Yaghi S; Department of Neurology, Rhode Island Hospital, Providence, RI, USA., Shu L; Department of Neurology, Rhode Island Hospital, Providence, RI, USA., Puetz V; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Kaiser DPO; Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Kaesmacher J; Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland., Mujanovic A; Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland., Marterstoc DC; Department of Neuroradiology, University of Erlangen, Erlangen, Germany., Engelhorn T; Department of Neuroradiology, University of Erlangen, Erlangen, Germany., Berberich A; Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany., Klein P; Department of Radiology, Boston Medical Center, Boston, MA, USA., Haussen DC; Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA., Mohammaden MH; Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA., Abdelhamid H; Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA., Fragata I; Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal., Cunha B; Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal., Romoli M; Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy., Hu W; Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China., Song J; Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China., Fifi JT; Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA., Matsoukas S; Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA., Sheth SA; Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA., Salazar-Marioni SA; Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA., Marto JP; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Ramos JN; Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Miszczuk M; Department of Neuroradiology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany., Riegler C; Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany., Poli S; Hertie-Institute for Clinical Brain Research, Tübingen University, Tübingen, Germany., Poli K; Hertie-Institute for Clinical Brain Research, Tübingen University, Tübingen, Germany., Jadhav AP; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA., Desai S; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA., Maus V; Department of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Kaeder M; Department of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany., Siddiqui AH; Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA., Monteiro A; Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA., Kokkonen T; Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Diana F; Department of Interventional Neuroradiology, University Hospital Vall d'Hebron, Barcelona, Spain., Masoud HE; Department of Neurology, New York Upstate Medical University, Syracuse, NY, USA., Suryadareva N; Department of Neurology, New York Upstate Medical University, Syracuse, NY, USA., Mokin M; Department of Neurosurgery, University of South Florida, Tampa, FL, USA., Thanki S; Department of Neurosurgery, University of South Florida, Tampa, FL, USA., Ylikotila P; Department of Neurology, Turku University Hospital and University of Turku, Turku, Finland., Alpay K; Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland., Siegler JE; Department of Neurology, University of Chicago, Chicago, IL, USA., Linfante I; Miami Neuroscience Institute, Miami, FL, USA., Dabus G; Miami Neuroscience Institute, Miami, FL, USA., Yavaghal D; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA., Saini V; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA., Nolte CH; Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany., Siebert E; Department of Neuroradiology, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health (BIH), Freie Universität Berlin and Humboldt-Universität, Berlin, Germany., Möhlenbruch MA; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany., Ringleb PA; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany., Nogueira RG; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Hanning U; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Meyer L; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Fischer U; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland., Strbian D; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Jazyk:	angličtina
Zdroj:	Journal of stroke [J Stroke] 2024 May; Vol. 26 (2), pp. 290-299. Date of Electronic Publication: 2024 May 30.
DOI:	10.5853/jos.2024.00458
Abstrakt:	Background and Purpose: Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. Methods: From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0-1) and independent outcome (mRS 0-2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. Results: Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3-P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79-1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05-2.12), sICH (aOR 2.87, 95% CI 1.23-6.72), and mortality (aOR 1.77, 95% CI 1.07-2.95). Conclusion: Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.
Databáze:	MEDLINE
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