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Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee
  1. Yasha Kayan1,
  2. Philip M Meyers2,
  3. Charles J Prestigiacomo3,
  4. Peter Kan4,
  5. Justin F Fraser5
  6. on Behalf of the Society of NeuroInterventional Surgery
    1. 1 Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
    2. 2 Neurointerventional Surgery, Columbia Presbyterian Hospital, New York City, New York, USA
    3. 3 Neurological Surgery, University of Cincinnati, Cincinnati, Ohio, USA
    4. 4 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
    5. 5 Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
    1. Correspondence to Dr Justin F Fraser, Neurological Surgery, University of Kentucky, 800Rose St Room MS105A, Lexington, KY40536, USA; Jfr235{at}


    Background The aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO).

    Methods We performed a review of the literature to specifically evaluate this disease and its treatments.

    Results Data were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus.

    Conclusion While many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.

    • thrombectomy
    • stroke
    • standards
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    • Contributors YK, PMM, and CJP were the primary authors and, as such, were responsible for overseeing construction of the document outline, gathering of evidence, and drafting of the manuscript. PK acted as a representative of the Board of the Society of NeuroInterventional Surgery, and provided commentary and editing on behalf of the Board and of the Society as a whole. JFF, as senior author, was responsible for organizing the writing group, overseeing the outline construction, facilitating communication between the writing group and the Standards and Guidelines Committee, drafting and editing of the manuscript, and the submission/proofing for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Disclaimer This literature review (’Review') is provided for informational and educational purposes only. Adherence to any recommendations included in this review will not ensure successful treatment in every situation. Furthermore, the recommendations contained in this review should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. This review and its conclusions and recommendations reflect the best available information at the time the review was prepared. The results of future studies may require revisions to the recommendations in this review to reflect new data. SNIS does not warrant the accuracy or completeness of the review and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this review or for any errors or omissions.

    • Competing interests JFF is an equity interest holder for Fawkes Biotechnology, LLC, and a consultant for Stream Biomedical and Medtronic Neurovascular. PK is a consultant for Stryker and Medtronic Neurovascular. YK is a consultant for Penumbra and for Medtronic Neurovascular. PMM is a consultant for Stryker, Medtronic, Penumbra, and Siemens. A S Arthur is a consultant for Balt, Johnson and Johnson, Leica, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker. He has research support from Cerenovus, Microvention, Penumbra, and Siemens. He is a shareholder in Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, and Vascular Simulations. B Baxter is a consultant for Penumbra, Medtronic, Stryker, Metactive, and 880 Medical. He has stock in Penumbra, and stock options in He has ownership interest in Route 92 and Marblehead. Dr Chen is a consultant for Medtronic, Stryker, Genentech, Imperative Health, Microvention, and Cerenovus. G Dabus is a consultant for Medtronic, Microvention, Penumbra, Stryker, and Cerenovus. He is a shareholder in InNeuroCo. K Fargen is a consultant for Cerebrotech. D Frei is a consultant for Genentech, Penumbra, and Stryker. He has stock ownership in Penumbra. S Hetts has a Royalty Agreement with Penumbra. He contracts for Core Imaging Lab for Stryker and MicroVention. He has a research contract with Siemens. He is on Data Safety and Monitoring Boards for DAWN, ARISE2, and PHIL trials. He has grant support through NCI and NIBIB. M S Hussain is a consultant for Cerenovus. M V Jayaraman is a speaker for Medtronic. R P Klucznik is a consultant for Medtronic and Microvention. W J Mack is a consultant for Rebound Therapeutics, Viseon TSP, Medtronic, Penumbra, and Stream Biomedical. He is an investor in Cerebrotech, Endostream, Viseon, and Rebound Therapeutics. R McTaggart is a consultant for Stryker. J Milburn is a consultant for Stryker and Penumbra. M Mokin is a consultant for Canon Medical, Cerebrotech, and Imperative Care. J Mocco receives research support from Stryker, Penumbra, Medtronic, and Microvention. He is a consultant for Imperative Care, Cerebrotech, Viseon, Endostream, Rebound Therapeutics, and Vastrax. He is an investor/shareholder in BlinkTBI, Serenity, NTI, Neurvana, and Cardinal Consulting. G L Pride is a consultant for Sequent and Microvention-Terumo. He is on the Data Safety and Monitoring Board for Web-IT Study (Cerenovus) and for the Pulserider NAPA trial. R M Starke receives research support from NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, NIH, Miami Clinical and Translational Science Institute, National Center for Advancing Translational Sciences, and the National Institute on Minority Health and Health Disparities. He is a consultant for Penumbra, Abbott, Medtronic, and Cerenovus. P J Sunenshine is a consultant for Medtronic. G Toth is a consultant for Dynamed EBSCO.

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

    • Collaborators A S Arthur, S Ansari, B Baxter, K Bulsara, G Dabus, K Fargen, D Frei, C D Gandhi, S Hetts, M S Hussain, M V Jayaraman, R P Klucznik, S K Lee, W J Mack, R McTaggart, T Leslie-Mazwi, J Milburn, M Mokin, J Mocco, A T Patsalides, G L Pride, R M Starke, P J Sunenshine, G Toth, Michael Chen.

    • Patient consent for publication Not required.

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