Lukas Meyer1, Christian Paul Stracke1,2, Noël Jungi3,4, Marta Wallocha5, Gabriel Broocks1, Peter B Sporns1,6, Christian Maegerlein7, Franziska Dorn8, Hanna Zimmermann8, Weis Naziri9,10, Nuran Abdullayev11, Christoph Kabbasch11, Daniel Behme12, Ala Jamous12, Volker Maus13, Sebastian Fischer13, Markus Möhlenbruch14, Charlotte Sabine Weyland14, Sönke Langner15, Dan Meila16, Milena Miszczuk17, Eberhard Siebert17, Stephan Lowens18, Lars Udo Krause19, Leonard L L Yeo20,21, Benjamin Yong-Qiang Tan20,21, Gopinathan Anil21,22, Benjamin Gory23,24, Jorge Galván25, Miguel Schüller Arteaga25, Pedro Navia26, Eytan Raz27, Maksim Shapiro27, Fabian Arnberg28, Kamil Zelenák29, Mario Martinez-Galdamez25, Urs Fischer4, Andreas Kastrup30, Christian Roth31, Panagiotis Papanagiotou31,32, André Kemmling9,10, Jan Gralla3, Marios-Nikos Psychogios6, Tommy Andersson28, Rene Chapot5, Jens Fiehler1, Johannes Kaesmacher3,33, Uta Hanning1. 1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany. 3. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 4. Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 5. Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany. 6. Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland. 7. Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany. 8. Institute of Neuroradiology, University Hospitals, Ludwig-Maximilians-Universität München, Munich, Germany. 9. Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany. 10. Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany. 11. Department of Neuroradiology, University of Cologne, Cologne, Germany. 12. Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Goettingen, Germany. 13. Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany. 14. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany. 15. Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Rostock, Germany. 16. Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany. 17. Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany. 18. Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany. 19. Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany. 20. Division of Neurology, Department of Medicine, National University Health System, Singapore. 21. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 22. Department of Diagnostic Imaging, National University Health System, Singapore. 23. Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France. 24. Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, INSERM U1254, Nancy, France. 25. Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 26. Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain. 27. Department of Radiology, New York Langone Medical Center, New York. 28. Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 29. Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia. 30. Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany. 31. Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany. 32. Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece. 33. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
Importance: Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective: To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Design, Setting, and Participants: This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Interventions: Mechanical thrombectomy or standard medical treatment with or without IVT. Main Outcomes and Measures: Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Results: Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. Conclusions and Relevance: This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.
Importance: Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective: To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Design, Setting, and Participants: This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Interventions: Mechanical thrombectomy or standard medical treatment with or without IVT. Main Outcomes and Measures: Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Results: Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. Conclusions and Relevance: This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.
Authors: Anna K Bonkhoff; Martin Bretzner; Sungmin Hong; Markus D Schirmer; Alexander Cohen; Robert W Regenhardt; Kathleen L Donahue; Marco J Nardin; Adrian V Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa C McIntosh; John Attia; Oscar R Benavente; Stephen Bevan; John W Cole; Amanda Donatti; Christoph J Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven J Kittner; Robin Lemmens; Christopher R Levi; Caitrin W McDonough; James F Meschia; Chia-Ling Phuah; Arndt Rolfs; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Martin Söderholm; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Johan Wasselius; Daniel Woo; Ramin Zand; Patrick F McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Michael D Fox; Danilo Bzdok; Ona Wu; Natalia S Rost Journal: Brain Commun Date: 2022-02-02
Authors: Anna K Bonkhoff; Markus D Schirmer; Martin Bretzner; Sungmin Hong; Robert W Regenhardt; Mikael Brudfors; Kathleen L Donahue; Marco J Nardin; Adrian V Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa C McIntosh; John Attia; Oscar R Benavente; Stephen Bevan; John W Cole; Amanda Donatti; Christoph J Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven J Kittner; Robin Lemmens; Christopher R Levi; Caitrin W McDonough; James F Meschia; Chia-Ling Phuah; Arndt Rolfs; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Martin Söderholm; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Johan Wasselius; Daniel Woo; Ramin Zand; Patrick F McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Danilo Bzdok; Ona Wu; Natalia S Rost Journal: Nat Commun Date: 2021-06-02 Impact factor: 14.919
Authors: Kamil Zeleňák; Antonín Krajina; Lukas Meyer; Jens Fiehler; Daniel Behme; Deniz Bulja; Jildaz Caroff; Amar Ajay Chotai; Valerio Da Ros; Jean-Christophe Gentric; Jeremy Hofmeister; Omar Kass-Hout; Özcan Kocatürk; Jeremy Lynch; Ernesto Pearson; Ivan Vukasinovic Journal: Life (Basel) Date: 2021-05-27
Authors: Christian Paul Stracke; Lukas Meyer; Wolfram Schwindt; Alexander Ranft; Ronald Straeter Journal: Front Neurol Date: 2022-02-22 Impact factor: 4.003
Authors: Manon Kappelhof; Johanna Ospel; Nima Kashani; Petra Cimflova; Nishita Singh; Mohammed A Almekhlafi; Bijoy K Menon; Jens Fiehler; Michael Chen; Nobuyuki Sakai; Mayank Goyal Journal: J Neurointerv Surg Date: 2021-05-25 Impact factor: 8.572