Endovascular treatment (EVT) for posterior large vessel occlusion (LVO) stroke was associated with high rates of successful reperfusion and favorable clinical outcome despite high mortality in this patient population, according to study findings published in Stroke.
Approximately 1% of all ischemic strokes comprise of LVO of the posterior circulation and are tied to a high risk of disability and death. EVT for LVO stroke has been proven safe and effective and therefore, warranted for posterior circulation. However, the benefit of EVT for posterior circulation stroke (PCS) and treatment outcomes in clinical practice is unclear.
The objective of the current study was to evaluate outcomes of patients with PCS treated with EVT in clinical practice.
The study included 264 patients (mean age, 65 years) with acute ischemic stroke who underwent EVT in an observational, multicenter randomized trial in the Netherlands between 2014 and 2018. The researchers assessed patients’ modified Rankin Scale (mRS) score at 90 days, with the primary outcome being a score of 0 to 3, indicative of a favorable functional outcome. The 7-point mRS ranged from 0 (no symptoms) to 6 (death). Reperfusion status and symptomatic intracranial hemorrhage were included as secondary outcomes.
At presentation, the median National Institutes of Health Stroke Scale (NIHSS) was 16. Intravenous thrombolysis was provided to 51% (n=135) of patients, and symptoms were considered “maximum” in 51% out of 254 patients. Basilar artery was the most often involved (77%). The median duration from the estimated time of LVO (eLVO) to groin puncture was 240 minutes, and approximately one-quarter (26%) of patients presented beyond 6 hours from eLVO. The mean duration of the procedure was 60 minutes.
A favorable functional outcome, defined by the mRS score of 0 to 3, was reported in 46% (n=115) of patients, while functional independence (mRs score, 0-2) was reported in 35% (n=87) of patients. Additionally, the median NIHSS at 24 hours was 8, and successful reperfusion was reported in 75% (n=178) of patients. Stroke progression was reported in 17% (n=46) of patients, and 3% (n=9) of patients had symptomatic intracranial hemorrhage. Approximately 43% (n=109) of patients died.
The researchers noted that they used the extended Thrombolysis in Cerebral Ischemia score to identify reperfusion status in this cohort; however, they explained that interobserver agreement for the tool as a recanalization scale seems lower for the posterior circulation vs the anterior circulation.
They concluded that additional “randomized studies using modern treatment approaches are needed for further insight in the benefit of EVT for” the treatment of posterior circulation stroke.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Pirson FAV, Boodt N, Brouwer J, et al. Endovascular treatment for posterior circulation stroke in routine clinical practice: Results of the multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands Registry. Stroke. Published online November 10, 2021. doi:10.1161/STROKEAHA.121.034786