Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke
Authors: Räty Silja , Nguyen Thanh N. , Nagel Simon , Strambo Davide , Michel Patrik , Herweh Christian , Qureshi Muhammad M. , Abdalkader Mohamad , Virtanen Pekka , Olive-Gadea Marta , Ribo Marc , Psychogios Marios , Nguyen Anh , Kuramatsu Joji B. , Haupenthal David , Köhrmann Martin , Deuschl Cornelius , Escolà Jordi Kühne , Demeestere Jelle , Lemmens Robin , Vandewalle Lieselotte , Yaghi Shadi , Shu Liqi , Puetz Volker , Kaiser Daniel P.O. , Kaesmacher Johannes , Mujanovic Adnan , Marterstoc Dominique Cornelius , Engelhorn Tobias , Berberich Anne , Klein Piers , Haussen Diogo C. , Mohammaden Mahmoud H. , Abdelhamid Hend , Fragata Isabel , Cunha Bruno , Romoli Michele , Hu Wei , Song Jianlon , Fifi Johanna T. , Matsoukas Stavros , Sheth Sunil A. , Salazar-Marioni Sergio A. , Marto João Pedro , Ramos João Nuno , Miszczuk Milena , Riegler Christoph , Poli Sven , Poli Khouloud , Jadhav Ashutosh P. , Desai Shashvat , Maus Volker , Kaeder Maximilian , Siddiqui Adnan H. , Monteiro Andre , Kokkonen Tatu , Diana Francesco , Masoud Hesham E. , Suryadareva Neil , Mokin Maxim , Thanki Shail , Ylikotila Pauli , Alpay Kemal , Siegler James E. , Linfante Italo , Dabus Guilherme , Yavaghal Dileep , Saini Vasu , Nolte Christian H. , Siebert Eberhart , Möhlenbruch Markus A. , Ringleb Peter A. , Nogueira Raul G. , Hanning Uta , Meyer Lukas , Fischer Urs , Strbian Daniel 
Published: May 2024

Background and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone.Methods From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment.Results Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95).Conclusion Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.