PDF(Pubmed)
Abstract：
OBJECTIVE: 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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
目的：大脑后动脉闭塞（PCAo）可导致长期残疾，然而,目前还缺乏指导最佳再灌注策略的随机对照试验.我们比较了接受或不接受静脉溶栓（IVT）的血管内血栓切除术（EVT）治疗的PCAo患者与仅接受IVT治疗的患者的预后。
方法：来自多中心回顾性大脑后部ArTery闭塞（PLATO）注册表，我们纳入了2015年1月至2022年8月发病24小时内接受再灌注治疗的孤立性PCAo患者.主要结果是3个月时改良的Rankin量表（mRS）的分布。其他结果包括3个月优（mRS0-1）和独立结果（mRS0-2），早期神经改善（ENI），死亡率,和症状性颅内出血（sICH）。使用逆概率加权回归调整比较治疗。
结果：在724名患者中，400例接受EVT+/-IVT和324例单独接受IVT（中位年龄74岁，57.7%男性)。入院时美国国立卫生研究院卒中量表评分中位数为7分,闭塞节段为P1分(43.9%),P2（48.3%），P3-P4（6.1%），双边(1.0%)，或胎儿大脑后动脉（0.7%）。与单独的IVT相比，EVT+/-IVT与改善的功能结局无关（调整后的共同比值比[OR]1.07，95％置信区间[CI]0.79-1.43）。EVT增加了ENI的几率(调整后OR[aOR]1.49，95%CI1.05-2.12)，SICH（AOR2.87，95%CI1.23-6.72），和死亡率（aOR1.77，95%CI1.07-2.95）。
结论：尽管早期改善的可能性较高，与PCAo后单独使用IVT相比，EVT+/-IVT不影响功能结局。这可能是由于EVT后sICH和死亡率增加的风险所致。
方法：来自多中心回顾性大脑后部ArTery闭塞（PLATO）注册表，我们纳入了2015年1月至2022年8月发病24小时内接受再灌注治疗的孤立性PCAo患者.主要结果是3个月时改良的Rankin量表（mRS）的分布。其他结果包括3个月优（mRS0-1）和独立结果（mRS0-2），早期神经改善（ENI），死亡率,和症状性颅内出血（sICH）。使用逆概率加权回归调整比较治疗。
结果：在724名患者中，400例接受EVT+/-IVT和324例单独接受IVT（中位年龄74岁，57.7%男性)。入院时美国国立卫生研究院卒中量表评分中位数为7分,闭塞节段为P1分(43.9%),P2（48.3%），P3-P4（6.1%），双边(1.0%)，或胎儿大脑后动脉（0.7%）。与单独的IVT相比，EVT+/-IVT与改善的功能结局无关（调整后的共同比值比[OR]1.07，95％置信区间[CI]0.79-1.43）。EVT增加了ENI的几率(调整后OR[aOR]1.49，95%CI1.05-2.12)，SICH（AOR2.87，95%CI1.23-6.72），和死亡率（aOR1.77，95%CI1.07-2.95）。
结论：尽管早期改善的可能性较高，与PCAo后单独使用IVT相比，EVT+/-IVT不影响功能结局。这可能是由于EVT后sICH和死亡率增加的风险所致。
