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Abstract：
UNASSIGNED: Acute ischemic stroke with isolated posterior cerebral artery occlusion (iPCAO) lacks management evidence from randomized trials. We aimed to evaluate whether the association between endovascular treatment (EVT) and outcomes in iPCAO acute ischemic stroke is modified by initial stroke severity (baseline National Institutes of Health Stroke Scale [NIHSS]) and arterial occlusion site.
UNASSIGNED: Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0-1), functional independence (mRS score 0-2), symptomatic intracranial hemorrhage, and mortality.
UNASSIGNED: From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution (Pinteraction=0.312) but did with functional independence (Pinteraction=0.010), with a similar trend on excellent outcome (Pinteraction=0.069). EVT was associated with more favorable outcomes than MM in patients with baseline NIHSS score >6 (mRS score 0-1, 30.6% versus 17.7%; adjusted odds ratio [aOR], 2.01 [95% CI, 1.22-3.31]; mRS score 0 to 2, 46.1% versus 31.9%; aOR, 1.64 [95% CI, 1.08-2.51]) but not in those with NIHSS score ≤6 (mRS score 0-1, 43.8% versus 46.3%; aOR, 0.90 [95% CI, 0.49-1.64]; mRS score 0-2, 65.3% versus 74.3%; aOR, 0.55 [95% CI, 0.30-1.0]). EVT was associated with more symptomatic intracranial hemorrhage regardless of baseline NIHSS score (Pinteraction=0.467), while the mortality increase was more pronounced in patients with NIHSS score ≤6 (Pinteraction=0.044; NIHSS score ≤6: aOR, 7.95 [95% CI, 3.11-20.28]; NIHSS score >6: aOR, 1.98 [95% CI, 1.08-3.65]). Arterial occlusion site did not modify the association of EVT with outcomes compared with MM.
UNASSIGNED: Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.
UNASSIGNED: Based on the multicenter, retrospective, case-control study of consecutive iPCAO acute ischemic stroke patients (PLATO study [Posterior Cerebral Artery Occlusion Stroke]), we assessed the heterogeneity of EVT outcomes compared with medical management (MM) for iPCAO, according to baseline NIHSS score (≤6 versus >6) and occlusion site (P1 versus P2), using multivariable regression modeling with interaction terms. The primary outcome was the favorable shift of 3-month modified Rankin Scale (mRS). Secondary outcomes included excellent outcome (mRS score 0-1), functional independence (mRS score 0-2), symptomatic intracranial hemorrhage, and mortality.
UNASSIGNED: From 1344 patients assessed for eligibility, 1059 were included (median age, 74 years; 43.7% women; 41.3% had intravenous thrombolysis): 364 receiving EVT and 695 receiving MM. Baseline stroke severity did not modify the association of EVT with 3-month mRS distribution (Pinteraction=0.312) but did with functional independence (Pinteraction=0.010), with a similar trend on excellent outcome (Pinteraction=0.069). EVT was associated with more favorable outcomes than MM in patients with baseline NIHSS score >6 (mRS score 0-1, 30.6% versus 17.7%; adjusted odds ratio [aOR], 2.01 [95% CI, 1.22-3.31]; mRS score 0 to 2, 46.1% versus 31.9%; aOR, 1.64 [95% CI, 1.08-2.51]) but not in those with NIHSS score ≤6 (mRS score 0-1, 43.8% versus 46.3%; aOR, 0.90 [95% CI, 0.49-1.64]; mRS score 0-2, 65.3% versus 74.3%; aOR, 0.55 [95% CI, 0.30-1.0]). EVT was associated with more symptomatic intracranial hemorrhage regardless of baseline NIHSS score (Pinteraction=0.467), while the mortality increase was more pronounced in patients with NIHSS score ≤6 (Pinteraction=0.044; NIHSS score ≤6: aOR, 7.95 [95% CI, 3.11-20.28]; NIHSS score >6: aOR, 1.98 [95% CI, 1.08-3.65]). Arterial occlusion site did not modify the association of EVT with outcomes compared with MM.
UNASSIGNED: Baseline clinical stroke severity, rather than the occlusion site, may be an important modifier of the association between EVT and outcomes in iPCAO. Only severely affected patients with iPCAO (NIHSS score >6) had more favorable disability outcomes with EVT than MM, despite increased mortality and symptomatic intracranial hemorrhage.
摘要：
背景：孤立性脑后动脉闭塞（iPCAO）的急性缺血性卒中（AIS）缺乏随机试验的治疗证据。我们的目的是评估血管内治疗（EVT）与iPCAO-AIS结果之间的关联是否因初始卒中严重程度（基线NIHSS）和动脉闭塞部位而改变。方法：基于多中心，回顾性,连续iPCAO-AIS患者的病例对照研究（PLATO研究），我们评估了EVT结果的异质性，与iPCAO的医疗管理（MM）相比，根据基线NIHSS(≤6vs.>6）和闭塞部位（P1vs.P2),使用具有交互项的多变量回归建模。主要结果是3个月mRS的有利转变。次要结果包括优秀结果（mRS0-1），功能独立性(MRS0-2)，症状性颅内出血（sICH）和死亡率。结果：从评估合格的1344名患者中，纳入1,059人(中位年龄74岁，43.7%的女性，41.3％进行了静脉溶栓），364接收EVT和695MM。基线卒中严重程度并未改变EVT与3个月mRS分布的相关性（pint=0.312），但具有功能独立性(品脱=0.010)，在优异的结果上有类似的趋势(品脱=0.069)。在基线NIHSS>6的患者中，EVT比MM具有更有利的结局（mRS0-1：30.6％vs.17.7%,aOR=2.01，95CI=1.22-3.31；mRS0-2：46.1%vs.31.9%,OR=1.64,95CI=1.08-2.51),但在NIHSS≤6的人群中没有（mRS0-1：43.8%与46.3%,aOR=0.90，95CI=0.49-1.64；mRS0-2：65.3%vs.74.3%,OR=0.55,95CI=0.30-1.0)。无论基线NIHSS如何，EVT与更多sICH相关(pint=0.467)，而NIHSS≤6的患者死亡率增加更为明显(pint=0.044,NIHSS≤6:aOR=7.95,95CI=3.11-20.28,NIHSS>6:aOR=1.98,95CI=1.08-3.65)。与MM相比，动脉闭塞部位并未改变EVT与结果的关联。结论：基线临床卒中严重程度，而不是闭塞部位，可能是iPCAO中EVT与结局之间关联的重要修饰因子。只有严重影响的iPCAO（NIHSS>6）患者的EVT残疾结果比MM更有利，尽管死亡率和sICH增加。
