Christian Maegerlein1, Tobias Boeckh-Behrens2, Silke Wunderlich3, Johannes Gerber4, Lars-Peder Pallesen5, Volker Puetz5. 1. Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. christian.maegerlein@tum.de. 2. Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. 3. Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. 4. Institut und Poliklinik für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland. 5. Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.
Abstract
BACKGROUND: Since the publication of the large randomized controlled thrombectomy trials, endovascular treatment (EVT) has become the standard of care for acute stroke patients with anterior circulation large vessel occlusion (acLVO); however, the treatment of patients with an intracranial occlusion in the posterior circulation and in particular of the basilar artery has not been proven. Thus, there is uncertainty regarding the indications for EVT due to the poor evidence situation. OBJECTIVE: This review article addresses the current data on EVT in the posterior circulation and the most recent study results. Furthermore, the pathophysiological aspects, indications and specific features in the treatment of these patients are also discussed. RESULTS: Despite limited evidence for EVT, this treatment modality has gained significant clinical relevance for the treatment of stroke patients with vascular occlusions in the posterior circulation. From a technical point of view, vascular occlusions in the posterior circulation and particularly of the basilar artery are easily accessible, although the etiology of occlusions and necessary techniques differ compared to occlusions in the anterior circulation. CONCLUSION: Compared to acLVO, EVT in the posterior circulation differs with respect to the current evidence, indications and technique. As current data have not proven its effectiveness for improved clinical outcome, treatment decisions must still be made individually based on institutional protocols, particularly for patients in the late time window or for patients already with signs of extensive infarction on baseline imaging.
BACKGROUND: Since the publication of the large randomized controlled thrombectomy trials, endovascular treatment (EVT) has become the standard of care for acute strokepatients with anterior circulation large vessel occlusion (acLVO); however, the treatment of patients with an intracranial occlusion in the posterior circulation and in particular of the basilar artery has not been proven. Thus, there is uncertainty regarding the indications for EVT due to the poor evidence situation. OBJECTIVE: This review article addresses the current data on EVT in the posterior circulation and the most recent study results. Furthermore, the pathophysiological aspects, indications and specific features in the treatment of these patients are also discussed. RESULTS: Despite limited evidence for EVT, this treatment modality has gained significant clinical relevance for the treatment of strokepatients with vascular occlusions in the posterior circulation. From a technical point of view, vascular occlusions in the posterior circulation and particularly of the basilar artery are easily accessible, although the etiology of occlusions and necessary techniques differ compared to occlusions in the anterior circulation. CONCLUSION: Compared to acLVO, EVT in the posterior circulation differs with respect to the current evidence, indications and technique. As current data have not proven its effectiveness for improved clinical outcome, treatment decisions must still be made individually based on institutional protocols, particularly for patients in the late time window or for patients already with signs of extensive infarction on baseline imaging.
Authors: M Berndt; H Poppert; K Steiger; J Pelisek; P Oberdieck; C Maegerlein; C Zimmer; S Wunderlich; B Friedrich; T Boeckh-Behrens; B Ikenberg Journal: Clin Neuroradiol Date: 2020-10-02 Impact factor: 3.649
Authors: Lukas Meyer; Christian Paul Stracke; Noël Jungi; Marta Wallocha; Gabriel Broocks; Peter B Sporns; Christian Maegerlein; Franziska Dorn; Hanna Zimmermann; Weis Naziri; Nuran Abdullayev; Christoph Kabbasch; Daniel Behme; Ala Jamous; Volker Maus; Sebastian Fischer; Markus Möhlenbruch; Charlotte Sabine Weyland; Sönke Langner; Dan Meila; Milena Miszczuk; Eberhard Siebert; Stephan Lowens; Lars Udo Krause; Leonard L L Yeo; Benjamin Yong-Qiang Tan; Gopinathan Anil; Benjamin Gory; Jorge Galván; Miguel Schüller Arteaga; Pedro Navia; Eytan Raz; Maksim Shapiro; Fabian Arnberg; Kamil Zelenák; Mario Martinez-Galdamez; Urs Fischer; Andreas Kastrup; Christian Roth; Panagiotis Papanagiotou; André Kemmling; Jan Gralla; Marios-Nikos Psychogios; Tommy Andersson; Rene Chapot; Jens Fiehler; Johannes Kaesmacher; Uta Hanning Journal: JAMA Neurol Date: 2021-04-01 Impact factor: 18.302