Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study
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Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. / Nguyen, Thanh N; Qureshi, Muhammad M; Strambo, Davide; Strbian, Daniel; Räty, Silja; Herweh, Christian; Abdalkader, Mohamad; Olive-Gadea, Marta; Ribo, Marc; Psychogios, Marios; Fischer, Urs; Nguyen, Anh; Kuramatsu, Joji B; Haupenthal, David; Köhrmann, Martin; Deuschl, Cornelius; Kühne Escola, Jordi; Yaghi, Shadi; Shu, Liqi; Puetz, Volker; Kaiser, Daniel P O; Kaesmacher, Johannes; Mujanovic, Adnan; Marterstock, Dominique Cornelius; Engelhorn, Tobias; Klein, Piers; Haussen, Diogo C; Mohammaden, Mahmoud H; Abdelhamid, Hend; Souza Viana, Lorena; Cunha, Bruno; Fragata, Isabel; Romoli, Michele; Diana, Francesco; Virtanen, Pekka; Lappalainen, Kimmo; Clark, Judith; Matsoukas, Stavros; Fifi, Johanna T; Sheth, Sunil A; Salazar-Marioni, Sergio; Marto, João Pedro; Ramos, João Nuno; Miszczuk, Milena; Riegler, Christoph; Jadhav, Ashutosh P; Desai, Shashvat M; Maus, Volker; Kaeder, Maximilian; Siddiqui, Adnan H; Monteiro, Andre; Masoud, Hesham E; Suryadevara, Neil; Mokin, Maxim; Thanki, Shail; Siegler, James E; Khalife, Jane; Linfante, Italo; Dabus, Guilherme; Asdaghi, Negar; Saini, Vasu; Nolte, Christian H; Siebert, Eberhard; Meinel, Thomas R; Finitsis, Stefanos; Möhlenbruch, Markus A; Ringleb, Peter A; Berberich, Anne; Nogueira, Raul G; Hanning, Uta; Meyer, Lukas; Michel, Patrik; Nagel, Simon.
in: STROKE, Jahrgang 54, Nr. 7, 07.2023, S. 1708-1717.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study
AU - Nguyen, Thanh N
AU - Qureshi, Muhammad M
AU - Strambo, Davide
AU - Strbian, Daniel
AU - Räty, Silja
AU - Herweh, Christian
AU - Abdalkader, Mohamad
AU - Olive-Gadea, Marta
AU - Ribo, Marc
AU - Psychogios, Marios
AU - Fischer, Urs
AU - Nguyen, Anh
AU - Kuramatsu, Joji B
AU - Haupenthal, David
AU - Köhrmann, Martin
AU - Deuschl, Cornelius
AU - Kühne Escola, Jordi
AU - Yaghi, Shadi
AU - Shu, Liqi
AU - Puetz, Volker
AU - Kaiser, Daniel P O
AU - Kaesmacher, Johannes
AU - Mujanovic, Adnan
AU - Marterstock, Dominique Cornelius
AU - Engelhorn, Tobias
AU - Klein, Piers
AU - Haussen, Diogo C
AU - Mohammaden, Mahmoud H
AU - Abdelhamid, Hend
AU - Souza Viana, Lorena
AU - Cunha, Bruno
AU - Fragata, Isabel
AU - Romoli, Michele
AU - Diana, Francesco
AU - Virtanen, Pekka
AU - Lappalainen, Kimmo
AU - Clark, Judith
AU - Matsoukas, Stavros
AU - Fifi, Johanna T
AU - Sheth, Sunil A
AU - Salazar-Marioni, Sergio
AU - Marto, João Pedro
AU - Ramos, João Nuno
AU - Miszczuk, Milena
AU - Riegler, Christoph
AU - Jadhav, Ashutosh P
AU - Desai, Shashvat M
AU - Maus, Volker
AU - Kaeder, Maximilian
AU - Siddiqui, Adnan H
AU - Monteiro, Andre
AU - Masoud, Hesham E
AU - Suryadevara, Neil
AU - Mokin, Maxim
AU - Thanki, Shail
AU - Siegler, James E
AU - Khalife, Jane
AU - Linfante, Italo
AU - Dabus, Guilherme
AU - Asdaghi, Negar
AU - Saini, Vasu
AU - Nolte, Christian H
AU - Siebert, Eberhard
AU - Meinel, Thomas R
AU - Finitsis, Stefanos
AU - Möhlenbruch, Markus A
AU - Ringleb, Peter A
AU - Berberich, Anne
AU - Nogueira, Raul G
AU - Hanning, Uta
AU - Meyer, Lukas
AU - Michel, Patrik
AU - Nagel, Simon
PY - 2023/7
Y1 - 2023/7
N2 - BACKGROUND: The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion.METHODS: This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale.RESULTS: Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002).CONCLUSIONS: In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.
AB - BACKGROUND: The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion.METHODS: This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale.RESULTS: Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002).CONCLUSIONS: In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.
KW - Humans
KW - Male
KW - Aged
KW - Aged, 80 and over
KW - Female
KW - Stroke
KW - Brain Ischemia/therapy
KW - Thrombectomy
KW - Case-Control Studies
KW - Posterior Cerebral Artery/diagnostic imaging
KW - Endovascular Procedures/adverse effects
KW - Intracranial Hemorrhages/etiology
KW - Treatment Outcome
U2 - 10.1161/STROKEAHA.123.042674
DO - 10.1161/STROKEAHA.123.042674
M3 - SCORING: Journal article
C2 - 37222709
VL - 54
SP - 1708
EP - 1717
JO - STROKE
JF - STROKE
SN - 0039-2499
IS - 7
ER -