Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management
Authors: Sabben Candice , Charbonneau Frédérique , Obadia Michael , Strambo Davide , Ong Elodie , Heldner Mirjam R , Henon Hilde , Ter Schiphorst Adrien , Legris Loïc , Agasse-Lafont Thomas , Sablot Denis , Nehme Nour , Sibon Igor , Triquenot-Bagan Aude , Wolff Valérie , Preterre Cécile , Rosso Charlotte , Mione Gioia , Poll Roxana , Papassin Jérémie , Aignatoaie Andreea , Weisenburger Lile David , Béjot Yannick , Moulin Solène , Carrera Emmanuel , Garnier Pierre , Michel Patrik , Mordasini Pasquale , Albers Gregory W , Turc Guillaume , Mazighi Mikael , Seners Pierre , Charbonneau Frédérique , Delvoye Francois , Obadia Michael , Savatovsky Julien , Mazighi Mikael , Seners Pierre , Strambo Davide , Michel Patrik , Saliou Guillaume , Ong Elodie , Berthezene Yves , Heldner Mirjam R. , Mordasini Pasquale , Antonenko Kateryna , Pilgram-Pastor Sara , Zbinden Martin , Henon Hilde , Bricout Nicolas , Ter Schiphorst Adrien , Arquizan Caroline , Costalat Vincent , Legris Loïc , Detante Olivier , Agasse-Lafont Thomas , Tracol Clément , Eugene François , Sablot Denis , Turc Guillaume , Ben Hassen Wagih , Nehme Nour , Pico Fernando , Sibon Igor , Ledure Sylvain , Triquenot-Bagan Aude , Gerardin Emmanuel , Wolff Valérie , Krug Mathieu , Pop Raoul , Kremer Stéphane , Preterre Cécile , Desal Hubert , Aignatoaie Andreea , Ozsancak Canan , Magni Christophe , Rosso Charlotte , Elhorany Mahmoud , Clarençon Frédéric , Richard Sébastien , Gory Benjamin , Mione Gioia , Poll Roxana , Niclot Philippe , Benammar Lynda , Papassin Jérémie , Moulin Solène , Soize Solène , Weisenburger Lile David , Lapergue Bertrand , Béjot Yannick , Comby Pierre-Olivier , Carrera Emmanuel , Garnier Pierre , Boutet Claire , Albers Gregory W. 
Published: December 2024

Background and Aims:

The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.

Methods:

We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6 h from symptoms onset in 26 stroke centers in France, Switzerland, and the United States, treated with the best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ⩾2 at 3 months or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable and then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.

Results:

Overall, 585 patients were included. The median age was 74 years (interquartile range (IQR) = 63–83), median National Institutes of Health Stroke Scale (NIHSS) was 6 (3–10), 80% received intravenous thrombolysis (IVT), and 22% and 78% had P1 and P2 occlusions, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted odds ratio (OR) = 1.12 per 5-year increase [95% confidence interval (CI) = 1.05–1.20]; p = 0.001), NIHSS score (aOR = 1.12 per each point increase [1.08–1.18]; p < 0.001), infarct volume (aOR = 1.16 per 5 mL increase [1.07-1.25]; p < 0.001), and the lack of IVT use (aOR = 1.79 [1.10-2.94], p = 0.020) were independently associated with poor outcome. Regarding 24-h follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR = 0.37 [95% CI = 0.21-0.65], p < 0.001) and parenchymal hematoma occurrence (aOR = 2.37 [95% CI = 1.01-5.56], p = 0.048) were independently associated with poor 3-month outcome.

Conclusions:

Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.