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Original research
Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: the MUSC experience
  1. Ali Alawieh1,2,
  2. Jan Vargas2,
  3. Raymond D Turner2,
  4. Aquilla S Turk2,
  5. M Imran Chaudry2,
  6. Jonathan Lena,
  7. Alejandro Spiotta2
  1. 1 Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Alejandro Spiotta, Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta{at}


Introduction In acute ischemic stroke (AIS), posterior circulation large vessel occlusions (LVOs) have been associated with poorer outcomes compared with anterior circulation LVOs. The outcomes of anterior versus posterior circulation thrombectomy for LVOs were compared at a high volume center employing a direct aspiration first pass technique (ADAPT).

Methods We retrospectively studied a database of AIS cases that underwent ADAPT thrombectomy for LVOs. Cases were grouped by anatomical location of thrombectomy (posterior vs anterior circulation), and analysis was performed on both entire sample size.

Results A total of 436 AIS patients (50.2% women, mean age 67.3 years) underwent ADAPT thrombectomy for LVO during the study period, of whom 13% of had posterior circulation thrombectomy. Patients with posterior circulation thrombectomy did not show a significant difference in preprocedural variables, including age, baseline National Institutes of Health Stroke Scale (NIHSS), and onset to groin time, compared with anterior circulation (P>0.05). There were also no differences in procedural variables between the two groups. Patients in the posterior group were found to have a similar likelihood of good outcome (modified Rankin Scale score 0—2) at 90 days compared with the anterior group (42.9% vs 43.2%, respectively), and a small but not significant increase in mortality at 90 days. Multilogistic regression analysis showed that the anatomical location (anterior vs posterior) was not an independent predictor of good outcome or mortality after thrombectomy. Prominent predictors of outcome/mortality included age, female gender, procedure time, and baseline NIHSS.

Conclusions Our findings demonstrate that when patients are carefully selected for thrombectomy, those with posterior circulation LVOs can achieve similar outcomes compared with anterior circulation thrombectomy, indicating comparable safety and efficacy profiles.

  • Stroke
  • Thrombectomy

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  • Contributors Each author listed above should receive authorship credit based on the material contribution to this article, their revision of this article, and their final approval of this article for submission to this journal.

  • Competing interests AS: Penumbra-consulting, honorarium, speaker bureau; Pulsar Vascular-consulting, honorarium, speaker bureau; Microvention-consulting, honorarium, speaker bureau, research; Stryker-consulting, honorarium, speaker bureau. AST, RDT, and MIC: Codman-consulting, honorarium, speaker bureau, research funding; Covidien-consulting, honorarium, speaker bureau; Penumbra-consulting, honorarium, speaker bureau, research grants; Microvention-consulting, honorarium, speaker bureau, research grants; Blockade-stock, consulting, honorarium, speaker bureau; Pulsar Vascular-stock, consulting, honorarium, speaker bureau, research; Medtronic-consulting, honorarium, speaker bureau.

  • Ethics approval The study was approved by the Medical University of South Carolina institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.