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Endovascular versus medical management of posterior cerebral artery occlusion stroke: the PLATO study

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 multi...

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Main Authors: Nguyen, Thanh N. (Author) , Qureshi, Muhammad M. (Author) , Strambo, Davide (Author) , Strbian, Daniel (Author) , Räty, Silja (Author) , Herweh, Christian (Author) , Abdalkader, Mohamad (Author) , Olive-Gadea, Marta (Author) , Ribo, Marc (Author) , Psychogios, Marios (Author) , Fischer, Urs (Author) , Nguyen, Anh (Author) , Kuramatsu, Joji B. (Author) , Haupenthal, David (Author) , Köhrmann, Martin (Author) , Deuschl, Cornelius (Author) , Kühne Escola, Jordi (Author) , Yaghi, Shadi (Author) , Shu, Liqi (Author) , Puetz, Volker (Author) , Kaiser, Daniel P.O. (Author) , Kaesmacher, Johannes (Author) , Mujanovic, Adnan (Author) , Marterstock, Dominique Cornelius (Author) , Engelhorn, Tobias (Author) , Klein, Piers (Author) , Haussen, Diogo C. (Author) , Mohammaden, Mahmoud H. (Author) , Abdelhamid, Hend (Author) , Souza Viana, Lorena (Author) , Cunha, Bruno (Author) , Fragata, Isabel (Author) , Romoli, Michele (Author) , Diana, Francesco (Author) , Virtanen, Pekka (Author) , Lappalainen, Kimmo (Author) , Clark, Judith (Author) , Matsoukas, Stavros (Author) , Fifi, Johanna T. (Author) , Sheth, Sunil A. (Author) , Salazar-Marioni, Sergio (Author) , Marto, João Pedro (Author) , Ramos, João Nuno (Author) , Miszczuk, Milena (Author) , Riegler, Christoph (Author) , Jadhav, Ashutosh P. (Author) , Desai, Shashvat M. (Author) , Maus, Volker (Author) , Kaeder, Maximilian (Author) , Siddiqui, Adnan H. (Author) , Monteiro, Andre (Author) , Masoud, Hesham E. (Author) , Suryadevara, Neil (Author) , Mokin, Maxim (Author) , Thanki, Shail (Author) , Siegler, James E. (Author) , Khalife, Jane (Author) , Linfante, Italo (Author) , Dabus, Guilherme (Author) , Asdaghi, Negar (Author) , Saini, Vasu (Author) , Nolte, Christian H. (Author) , Siebert, Eberhard (Author) , Meinel, Thomas Raphael (Author) , Finitsis, Stefanos (Author) , Möhlenbruch, Markus Alfred (Author) , Ringleb, Peter A. (Author) , Berberich, Anne (Author) , Nogueira, Raul G. (Author) , Hanning, Uta (Author) , Meyer, Lukas (Author) , Michel, Patrik (Author) , Nagel, Simon (Author)
Format: Article (Journal)
Language:English
Published: July 2023
In: Stroke
Year: 2023, Volume: 54, Issue: 7, Pages: 1708-1717
ISSN:1524-4628
DOI:10.1161/STROKEAHA.123.042674
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1161/STROKEAHA.123.042674
Verlag, kostenfrei, Volltext: https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.042674
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Author Notes:Thanh N. Nguyen, Muhammad M. Qureshi, Davide Strambo, Daniel Strbian, Silja Räty, Christian Herweh, Mohamad Abdalkader, Marta Olive-Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji B. Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escola, Shadi Yaghi, Liqi Shu, Volker Puetz, Daniel P.O. Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstock, Tobias Engelhorn, Piers Klein, Diogo C. Haussen, Mahmoud H. Mohammaden, Hend Abdelhamid, Lorena Souza Viana, Bruno Cunha, Isabel Fragata, Michele Romoli, Francesco Diana, Pekka Virtanen, Kimmo Lappalainen, Judith Clark, Stavros Matsoukas, Johanna T. Fifi, Sunil A. Sheth, Sergio Salazar-Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Ashutosh P. Jadhav, Shashvat M. Desai, Volker Maus, Maximilian Kaeder, Adnan H. Siddiqui, Andre Monteiro, Hesham E. Masoud, Neil Suryadevara, Maxim Mokin, Shail Thanki, James E. Siegler, Jane Khalife, Italo Linfante, Guilherme Dabus, Negar Asdaghi, Vasu Saini, Christian H. Nolte, Eberhard Siebert, Thomas R. Meinel, Stefanos Finitsis, Markus A. Möhlenbruch, Peter A. Ringleb, Anne Berberich, Raul G. Nogueira, Uta Hanning, Lukas Meyer, Patrik Michel, Simon Nagel

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520 |a 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. 
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Nguyen, Muhammad M. Qureshi, Davide Strambo, Daniel Strbian, Silja Räty, Christian Herweh, Mohamad Abdalkader, Marta Olive-Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji B. Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escola, Shadi Yaghi, Liqi Shu, Volker Puetz, Daniel P.O. Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstock, Tobias Engelhorn, Piers Klein, Diogo C. Haussen, Mahmoud H. Mohammaden, Hend Abdelhamid, Lorena Souza Viana, Bruno Cunha, Isabel Fragata, Michele Romoli, Francesco Diana, Pekka Virtanen, Kimmo Lappalainen, Judith Clark, Stavros Matsoukas, Johanna T. Fifi, Sunil A. Sheth, Sergio Salazar-Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Ashutosh P. Jadhav, Shashvat M. Desai, Volker Maus, Maximilian Kaeder, Adnan H. Siddiqui, Andre Monteiro, Hesham E. Masoud, Neil Suryadevara, Maxim Mokin, Shail Thanki, James E. Siegler, Jane Khalife, Italo Linfante, Guilherme Dabus, Negar Asdaghi, Vasu Saini, Christian H. Nolte, Eberhard Siebert, Thomas R. Meinel, Stefanos Finitsis, Markus A. Möhlenbruch, Peter A. Ringleb, Anne Berberich, Raul G. Nogueira, Uta Hanning, Lukas Meyer, Patrik Michel, Simon Nagel"]},"language":["eng"]} 
SRT |a NGUYENTHANENDOVASCUL2023 

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