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Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study

BACKGROUND: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparat...

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Main Authors: Salim, Hamza (Author) , Pulli, Benjamin (Author) , Yedavalli, Vivek (Author) , Musmar, Basel (Author) , Adeeb, Nimer (Author) , Lakhani, Dhairya (Author) , Essibayi, Muhammed Amir (Author) , El Naamani, Kareem (Author) , Henninger, Nils (Author) , Sundararajan, Sri Hari (Author) , Kühn, Anna Luisa (Author) , Khalife, Jane (Author) , Ghozy, Sherief (Author) , Scarcia, Luca (Author) , Grewal, Inayat (Author) , Tan, Benjamin Yq (Author) , Regenhardt, Robert W. (Author) , Heit, Jeremy J. (Author) , Cancelliere, Nicole M. (Author) , Bernstock, Joshua D. (Author) , Rouchaud, Aymeric (Author) , Fiehler, Jens (Author) , Sheth, Sunil (Author) , Puri, Ajit S. (Author) , Dyzmann, Christian (Author) , Colasurdo, Marco (Author) , Barreau, Xavier (Author) , Renieri, Leonardo (Author) , Filipe, João Pedro (Author) , Harker, Pablo (Author) , Radu, Răzvan Alexandru (Author) , Abdalkader, Mohamad (Author) , Klein, Piers (Author) , Marotta, Thomas R. (Author) , Spears, Julian (Author) , Ota, Takahiro (Author) , Mowla, Ashkan (Author) , Jabbour, Pascal (Author) , Biswas, Arundhati (Author) , Clarençon, Frédéric (Author) , Siegler, James E. (Author) , Nguyen, Thanh N. (Author) , Varela, Ricardo (Author) , Baker, Amanda (Author) , Altschul, David (Author) , Gonzalez, Nestor R. (Author) , Möhlenbruch, Markus Alfred (Author) , Costalat, Vincent (Author) , Gory, Benjamin (Author) , Stracke, Christian Paul (Author) , Aziz-Sultan, Mohammad Ali (Author) , Hecker, Constantin (Author) , Shaikh, Hamza (Author) , Griessenauer, Christoph J. (Author) , Liebeskind, David S. (Author) , Pedicelli, Alessandro (Author) , Alexandre, Andrea M. (Author) , Tancredi, Illario (Author) , Faizy, Tobias D. (Author) , Kalsoum, Erwah (Author) , Lubicz, Boris (Author) , Patel, Aman B. (Author) , Pereira, Vitor Mendes (Author) , Wintermark, Max (Author) , Guenego, Adrien (Author) , Dmytriw, Adam A. (Author)
Format: Article (Journal)
Language:English
Published: June 2025
In: European stroke journal
Year: 2025, Volume: 10, Issue: 2, Pages: 387-396
ISSN:2396-9881
DOI:10.1177/23969873241291465
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1177/23969873241291465
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Author Notes:Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Dhairya Lakhani, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Inayat Grewal, Benjamin Yq Tan, Robert W. Regenhardt, Jeremy J. Heit, Nicole M. Cancelliere, Joshua D. Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R. Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R. Gonzalez, Markus A. Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, Christoph J. Griessenauer, David S. Liebeskind, Alessandro Pedicelli, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, and Adam A. Dmytriw; for the MAD MT Investigators
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Summary:BACKGROUND: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo. - METHODS: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications. - RESULTS: A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups. - CONCLUSION: EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.
Item Description:Online veröffentlicht: October 21, 2024
Gesehen am 19.08.2025
Physical Description:Online Resource
ISSN:2396-9881
DOI:10.1177/23969873241291465

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