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Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study

Standard

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study. / Meyer, Lukas; Stracke, Christian Paul; Jungi, Noël; Wallocha, Marta; Broocks, Gabriel; Sporns, Peter B; Maegerlein, Christian; Dorn, Franziska; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Behme, Daniel; Jamous, Ala; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus; Weyland, Charlotte Sabine; Langner, Sönke; Meila, Dan; Miszczuk, Milena; Siebert, Eberhard; Lowens, Stephan; Krause, Lars Udo; Yeo, Leonard L L; Tan, Benjamin Yong-Qiang; Anil, Gopinathan; Gory, Benjamin; Galván, Jorge; Arteaga, Miguel Schüller; Navia, Pedro; Raz, Eytan; Shapiro, Maksim; Arnberg, Fabian; Zelenák, Kamil; Martinez-Galdamez, Mario; Fischer, Urs; Kastrup, Andreas; Roth, Christian; Papanagiotou, Panagiotis; Kemmling, André; Gralla, Jan; Psychogios, Marios-Nikos; Andersson, Tommy; Chapot, Rene; Fiehler, Jens; Kaesmacher, Johannes; Hanning, Uta.

in: JAMA NEUROL, Jahrgang 78, Nr. 4, 01.04.2021, S. 434-444.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Meyer, L, Stracke, CP, Jungi, N, Wallocha, M, Broocks, G, Sporns, PB, Maegerlein, C, Dorn, F, Zimmermann, H, Naziri, W, Abdullayev, N, Kabbasch, C, Behme, D, Jamous, A, Maus, V, Fischer, S, Möhlenbruch, M, Weyland, CS, Langner, S, Meila, D, Miszczuk, M, Siebert, E, Lowens, S, Krause, LU, Yeo, LLL, Tan, BY-Q, Anil, G, Gory, B, Galván, J, Arteaga, MS, Navia, P, Raz, E, Shapiro, M, Arnberg, F, Zelenák, K, Martinez-Galdamez, M, Fischer, U, Kastrup, A, Roth, C, Papanagiotou, P, Kemmling, A, Gralla, J, Psychogios, M-N, Andersson, T, Chapot, R, Fiehler, J, Kaesmacher, J & Hanning, U 2021, 'Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study', JAMA NEUROL, Jg. 78, Nr. 4, S. 434-444. https://doi.org/10.1001/jamaneurol.2021.0001

APA

Meyer, L., Stracke, C. P., Jungi, N., Wallocha, M., Broocks, G., Sporns, P. B., Maegerlein, C., Dorn, F., Zimmermann, H., Naziri, W., Abdullayev, N., Kabbasch, C., Behme, D., Jamous, A., Maus, V., Fischer, S., Möhlenbruch, M., Weyland, C. S., Langner, S., ... Hanning, U. (2021). Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study. JAMA NEUROL, 78(4), 434-444. https://doi.org/10.1001/jamaneurol.2021.0001

Vancouver

Meyer L, Stracke CP, Jungi N, Wallocha M, Broocks G, Sporns PB et al. Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study. JAMA NEUROL. 2021 Apr 1;78(4):434-444. https://doi.org/10.1001/jamaneurol.2021.0001

Bibtex

@article{ee2287b3374a4ecc8696ec2b0243f1e0,
title = "Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study",
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.",
author = "Lukas Meyer and Stracke, {Christian Paul} and No{\"e}l Jungi and Marta Wallocha and Gabriel Broocks and Sporns, {Peter B} and Christian Maegerlein and Franziska Dorn and Hanna Zimmermann and Weis Naziri and Nuran Abdullayev and Christoph Kabbasch and Daniel Behme and Ala Jamous and Volker Maus and Sebastian Fischer and Markus M{\"o}hlenbruch and Weyland, {Charlotte Sabine} and S{\"o}nke Langner and Dan Meila and Milena Miszczuk and Eberhard Siebert and Stephan Lowens and Krause, {Lars Udo} and Yeo, {Leonard L L} and Tan, {Benjamin Yong-Qiang} and Gopinathan Anil and Benjamin Gory and Jorge Galv{\'a}n and Arteaga, {Miguel Sch{\"u}ller} and Pedro Navia and Eytan Raz and Maksim Shapiro and Fabian Arnberg and Kamil Zelen{\'a}k and Mario Martinez-Galdamez and Urs Fischer and Andreas Kastrup and Christian Roth and Panagiotis Papanagiotou and Andr{\'e} Kemmling and Jan Gralla and Marios-Nikos Psychogios and Tommy Andersson and Rene Chapot and Jens Fiehler and Johannes Kaesmacher and Uta Hanning",
year = "2021",
month = apr,
day = "1",
doi = "10.1001/jamaneurol.2021.0001",
language = "English",
volume = "78",
pages = "434--444",
journal = "JAMA NEUROL",
issn = "2168-6149",
publisher = "American Medical Association",
number = "4",

}

RIS

TY - JOUR

T1 - Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study

AU - Meyer, Lukas

AU - Stracke, Christian Paul

AU - Jungi, Noël

AU - Wallocha, Marta

AU - Broocks, Gabriel

AU - Sporns, Peter B

AU - Maegerlein, Christian

AU - Dorn, Franziska

AU - Zimmermann, Hanna

AU - Naziri, Weis

AU - Abdullayev, Nuran

AU - Kabbasch, Christoph

AU - Behme, Daniel

AU - Jamous, Ala

AU - Maus, Volker

AU - Fischer, Sebastian

AU - Möhlenbruch, Markus

AU - Weyland, Charlotte Sabine

AU - Langner, Sönke

AU - Meila, Dan

AU - Miszczuk, Milena

AU - Siebert, Eberhard

AU - Lowens, Stephan

AU - Krause, Lars Udo

AU - Yeo, Leonard L L

AU - Tan, Benjamin Yong-Qiang

AU - Anil, Gopinathan

AU - Gory, Benjamin

AU - Galván, Jorge

AU - Arteaga, Miguel Schüller

AU - Navia, Pedro

AU - Raz, Eytan

AU - Shapiro, Maksim

AU - Arnberg, Fabian

AU - Zelenák, Kamil

AU - Martinez-Galdamez, Mario

AU - Fischer, Urs

AU - Kastrup, Andreas

AU - Roth, Christian

AU - Papanagiotou, Panagiotis

AU - Kemmling, André

AU - Gralla, Jan

AU - Psychogios, Marios-Nikos

AU - Andersson, Tommy

AU - Chapot, Rene

AU - Fiehler, Jens

AU - Kaesmacher, Johannes

AU - Hanning, Uta

PY - 2021/4/1

Y1 - 2021/4/1

N2 - 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.

AB - 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.

U2 - 10.1001/jamaneurol.2021.0001

DO - 10.1001/jamaneurol.2021.0001

M3 - SCORING: Journal article

C2 - 33616642

VL - 78

SP - 434

EP - 444

JO - JAMA NEUROL

JF - JAMA NEUROL

SN - 2168-6149

IS - 4

ER -