Abstract：
BACKGROUND: Whereas mechanical thrombectomy (MT) has become standard-of-care treatment for patients with salvageable brain tissue after acute stroke caused by large-vessel occlusions, the results of MT in patients with medium-vessel occlusions (MEVOs), particularly in the posterior cerebral artery (PCA), are not well known.
METHODS: Using data from the international Stroke Thrombectomy and Aneurysm Registry (STAR), we assessed presenting characteristics and clinical outcomes for patients who underwent MT for primary occlusions in the P2 PCA segment. As a subanalysis, we compared the PCA MeVO outcomes with STAR\'s anterior circulation MeVO outcomes, namely middle cerebral artery (MCA) M2 and M3 segments.
RESULTS: Of the 9812 patients in STAR, 43 underwent MT for isolated PCA MeVOs. The patients\' median age was 69 years (interquartile range 61-79), and 48.8% were female. The median NIH Stroke Scale score was 9 (range 6-17). After recanalization, 67.4% of patients achieved successful recanalization (modified treatment in cerebral infarction score [mTICI] ≥ 2b), with a first-pass success rate of 44.2%, and 39.6% achieved a modified Rankin score of 0-2 at 90 days. Nine patients (20.9%) had died by the 90-day follow-up. In comparison with M2 and M3 MeVOs, there were no differences in presenting characteristics among the three groups. Patients with PCA MeVOs were less likely to undergo intra-arterial thrombolysis (4.7% PCA vs. 10.1% M2 vs. 16.2% M3, p = 0.046) or to achieve successful recanalization (mTICI ≥ 2b, 67.4%, 86.7%, 82.3%, respectively, p < 0.001); however, there were no differences in the rates of successful first-pass recanalization (44.2%, 49.8%, 52.3%, respectively, p = 0.65).
CONCLUSIONS: We describe the STAR experience performing MT in patients with PCA MeVOs. Our analysis supports that successful first-pass recanalization can be achieved in PCA MEVOs at a rate similar to that in MCA MeVOs, although further study and possible innovation may be necessary to improve successful PCA MeVO recanalization rates.
METHODS: Using data from the international Stroke Thrombectomy and Aneurysm Registry (STAR), we assessed presenting characteristics and clinical outcomes for patients who underwent MT for primary occlusions in the P2 PCA segment. As a subanalysis, we compared the PCA MeVO outcomes with STAR\'s anterior circulation MeVO outcomes, namely middle cerebral artery (MCA) M2 and M3 segments.
RESULTS: Of the 9812 patients in STAR, 43 underwent MT for isolated PCA MeVOs. The patients\' median age was 69 years (interquartile range 61-79), and 48.8% were female. The median NIH Stroke Scale score was 9 (range 6-17). After recanalization, 67.4% of patients achieved successful recanalization (modified treatment in cerebral infarction score [mTICI] ≥ 2b), with a first-pass success rate of 44.2%, and 39.6% achieved a modified Rankin score of 0-2 at 90 days. Nine patients (20.9%) had died by the 90-day follow-up. In comparison with M2 and M3 MeVOs, there were no differences in presenting characteristics among the three groups. Patients with PCA MeVOs were less likely to undergo intra-arterial thrombolysis (4.7% PCA vs. 10.1% M2 vs. 16.2% M3, p = 0.046) or to achieve successful recanalization (mTICI ≥ 2b, 67.4%, 86.7%, 82.3%, respectively, p < 0.001); however, there were no differences in the rates of successful first-pass recanalization (44.2%, 49.8%, 52.3%, respectively, p = 0.65).
CONCLUSIONS: We describe the STAR experience performing MT in patients with PCA MeVOs. Our analysis supports that successful first-pass recanalization can be achieved in PCA MEVOs at a rate similar to that in MCA MeVOs, although further study and possible innovation may be necessary to improve successful PCA MeVO recanalization rates.
摘要：
背景：尽管机械血栓切除术（MT）已成为由大血管闭塞引起的急性卒中后可挽救脑组织的患者的标准治疗方法，中等血管闭塞（MEVOs）患者的MT结果，特别是在大脑后动脉（PCA），不是众所周知的。
方法：使用来自国际卒中血栓切除术和动脉瘤登记（STAR）的数据，我们评估了因P2PCA节段原发性闭塞而接受MT的患者的特征和临床结局.作为一个子分析，我们将PCAMeVO结果与STAR的前循环MeVO结果进行了比较，即大脑中动脉(MCA)M2和M3段。
结果：在STAR的9812名患者中，43例进行了MT分离的PCAMeVOs。患者的中位年龄为69岁（四分位距61-79），女性占48.8%。NIH卒中量表评分中位数为9分（6-17分）。再通后,67.4%的患者成功再通（脑梗死评分[mTICI]≥2b的改良治疗），首过成功率为44.2%,39.6%的人在90天时获得了0-2的改良Rankin评分。9名患者（20.9%）在90天的随访中死亡。与M2和M3MeVOs相比，三组在呈现特征方面没有差异.PCAMeVOs患者接受动脉内溶栓的可能性较小(4.7%PCA与10.1%M2与16.2%M3，p=0.046)或实现成功再通(mTICI≥2b，67.4%,86.7%,82.3%,分别,p<0.001)；然而，首过再通成功率没有差异(44.2%，49.8%,52.3%,分别,p=0.65）。
结论：我们描述了在PCAMeVOs患者中进行MT的STAR经验。我们的分析支持，在PCAMEVOs中可以以与MCAMEVOs相似的速度实现成功的首通再通，尽管可能需要进一步的研究和可能的创新来提高成功的PCAMeVO再通率。
方法：使用来自国际卒中血栓切除术和动脉瘤登记（STAR）的数据，我们评估了因P2PCA节段原发性闭塞而接受MT的患者的特征和临床结局.作为一个子分析，我们将PCAMeVO结果与STAR的前循环MeVO结果进行了比较，即大脑中动脉(MCA)M2和M3段。
结果：在STAR的9812名患者中，43例进行了MT分离的PCAMeVOs。患者的中位年龄为69岁（四分位距61-79），女性占48.8%。NIH卒中量表评分中位数为9分（6-17分）。再通后,67.4%的患者成功再通（脑梗死评分[mTICI]≥2b的改良治疗），首过成功率为44.2%,39.6%的人在90天时获得了0-2的改良Rankin评分。9名患者（20.9%）在90天的随访中死亡。与M2和M3MeVOs相比，三组在呈现特征方面没有差异.PCAMeVOs患者接受动脉内溶栓的可能性较小(4.7%PCA与10.1%M2与16.2%M3，p=0.046)或实现成功再通(mTICI≥2b，67.4%,86.7%,82.3%,分别,p<0.001)；然而，首过再通成功率没有差异(44.2%，49.8%,52.3%,分别,p=0.65）。
结论：我们描述了在PCAMeVOs患者中进行MT的STAR经验。我们的分析支持，在PCAMEVOs中可以以与MCAMEVOs相似的速度实现成功的首通再通，尽管可能需要进一步的研究和可能的创新来提高成功的PCAMeVO再通率。
