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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, Vol. 54, No. 7, 07.2023, p. 1708-1717.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Nguyen, TN, Qureshi, MM, Strambo, D, Strbian, D, Räty, S, Herweh, C, Abdalkader, M, Olive-Gadea, M, Ribo, M, Psychogios, M, Fischer, U, Nguyen, A, Kuramatsu, JB, Haupenthal, D, Köhrmann, M, Deuschl, C, Kühne Escola, J, Yaghi, S, Shu, L, Puetz, V, Kaiser, DPO, Kaesmacher, J, Mujanovic, A, Marterstock, DC, Engelhorn, T, Klein, P, Haussen, DC, Mohammaden, MH, Abdelhamid, H, Souza Viana, L, Cunha, B, Fragata, I, Romoli, M, Diana, F, Virtanen, P, Lappalainen, K, Clark, J, Matsoukas, S, Fifi, JT, Sheth, SA, Salazar-Marioni, S, Marto, JP, Ramos, JN, Miszczuk, M, Riegler, C, Jadhav, AP, Desai, SM, Maus, V, Kaeder, M, Siddiqui, AH, Monteiro, A, Masoud, HE, Suryadevara, N, Mokin, M, Thanki, S, Siegler, JE, Khalife, J, Linfante, I, Dabus, G, Asdaghi, N, Saini, V, Nolte, CH, Siebert, E, Meinel, TR, Finitsis, S, Möhlenbruch, MA, Ringleb, PA, Berberich, A, Nogueira, RG, Hanning, U, Meyer, L, Michel, P & Nagel, S 2023, 'Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study', STROKE, vol. 54, no. 7, pp. 1708-1717. https://doi.org/10.1161/STROKEAHA.123.042674

APA

Nguyen, T. N., Qureshi, M. M., Strambo, D., Strbian, D., Räty, S., Herweh, C., Abdalkader, M., Olive-Gadea, M., Ribo, M., Psychogios, M., Fischer, U., Nguyen, A., Kuramatsu, J. B., Haupenthal, D., Köhrmann, M., Deuschl, C., Kühne Escola, J., Yaghi, S., Shu, L., ... Nagel, S. (2023). Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. STROKE, 54(7), 1708-1717. https://doi.org/10.1161/STROKEAHA.123.042674

Vancouver

Nguyen TN, Qureshi MM, Strambo D, Strbian D, Räty S, Herweh C et al. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. STROKE. 2023 Jul;54(7):1708-1717. https://doi.org/10.1161/STROKEAHA.123.042674

Bibtex

@article{66728a041b7f48cbb6e4641b0fd1f1cc,
title = "Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study",
abstract = "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.",
keywords = "Humans, Male, Aged, Aged, 80 and over, Female, Stroke, Brain Ischemia/therapy, Thrombectomy, Case-Control Studies, Posterior Cerebral Artery/diagnostic imaging, Endovascular Procedures/adverse effects, Intracranial Hemorrhages/etiology, Treatment Outcome",
author = "Nguyen, {Thanh N} and Qureshi, {Muhammad M} and Davide Strambo and Daniel Strbian and Silja R{\"a}ty and Christian Herweh and Mohamad Abdalkader and Marta Olive-Gadea and Marc Ribo and Marios Psychogios and Urs Fischer and Anh Nguyen and Kuramatsu, {Joji B} and David Haupenthal and Martin K{\"o}hrmann and Cornelius Deuschl and {K{\"u}hne Escola}, Jordi and Shadi Yaghi and Liqi Shu and Volker Puetz and Kaiser, {Daniel P O} and Johannes Kaesmacher and Adnan Mujanovic and Marterstock, {Dominique Cornelius} and Tobias Engelhorn and Piers Klein and Haussen, {Diogo C} and Mohammaden, {Mahmoud H} and Hend Abdelhamid and {Souza Viana}, Lorena and Bruno Cunha and Isabel Fragata and Michele Romoli and Francesco Diana and Pekka Virtanen and Kimmo Lappalainen and Judith Clark and Stavros Matsoukas and Fifi, {Johanna T} and Sheth, {Sunil A} and Sergio Salazar-Marioni and Marto, {Jo{\~a}o Pedro} and Ramos, {Jo{\~a}o Nuno} and Milena Miszczuk and Christoph Riegler and Jadhav, {Ashutosh P} and Desai, {Shashvat M} and Volker Maus and Maximilian Kaeder and Siddiqui, {Adnan H} and Andre Monteiro and Masoud, {Hesham E} and Neil Suryadevara and Maxim Mokin and Shail Thanki and Siegler, {James E} and Jane Khalife and Italo Linfante and Guilherme Dabus and Negar Asdaghi and Vasu Saini and Nolte, {Christian H} and Eberhard Siebert and Meinel, {Thomas R} and Stefanos Finitsis and M{\"o}hlenbruch, {Markus A} and Ringleb, {Peter A} and Anne Berberich and Nogueira, {Raul G} and Uta Hanning and Lukas Meyer and Patrik Michel and Simon Nagel",
year = "2023",
month = jul,
doi = "10.1161/STROKEAHA.123.042674",
language = "English",
volume = "54",
pages = "1708--1717",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

RIS

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 -