Objective 20% of all acute ischemic strokes (AIS) occur in the posterior circulation (PC), which carry a high mortality rate close to 95%. Early recanalization improves outcomes as shown by several reports. Often trials excluded patients with posterior circulation strokes. We sought to investigate the prevalence, safety, and the clinical outcomes of PC-MT at our institution.
Methods A retrospective review of patients presenting with PC AIS who underwent mechanical thrombectomy at a tertiary referral center between 2010 and 2018.
Results Out of 453 patients who underwent mechanical thrombectomy for AIS, 45 patients had a PC stroke (av age 58 years, 56% male). The mean NIHSS upon admission was 17 (95%CI:14–20). The mean time from symptoms onset to groin puncture was 9 hours (95%CI:6–11), the mean procedure time was 53 minutes (95%CI:43–64) and mean time to revascularization, from symptoms onset was 866 minutes (95%CI:602–1129). Only 33% received tPA. Vessels involved included the basilar artery (87%, n=39), the posterior cerebral artery (4%, n=2), and the vertebral artery (9%, n=4). The procedures were divided into stentreiver alone (22%, n=10), aspiration alone (13%, n=6), and stentreiver with aspiration (51%, n=23), and failed procedure in 13% (n=6) of individuals. Most procedures required one pass to recanalize the vessel (44%, n=20). TICI > 2b was achieved in 69% of the subjects. Mean length of stay was 11 days (95%CI:8–14). Mortality rate was 38% and independent functional outcome of mRS <2 at three months was seen in 20% of the patients. On univariate analysis extravasation was significantly higher in PC compared to anterior circulation (AC) (9% vs 4%, p<0.01) as well as post-procedural sICH (13% vs. 4%,p=0.01); vessel recanalization (TICI >2b) was significantly lower in PC compared to AC (70% vs 90%,p<0.01); mortality rate was significantly higher in patients with PC compared to AC (38% vs 9%, p<0.01). On multivariate analysis AC had a significantly shorter LOS by about three days, compared to PC (coef:-3.04, 95%CI: -6.05 to -0.14, p<0.05). There was no difference in odds of achieving a good TICI score. The AC group also had almost four times greater odds of having a good mRS (OR: 3.69, 95%CI:1.06–12.8, p<0.05). They also had significantly lower odds of mortality, by around eighty-eight percent (OR:0.12, 95%CI: 0.05–0.31, p<0.01).
Conclusions MT is a safe and efficacious first-line therapy for PC strokes. PC-MT provides a high rate of recanalization without procedural complications. Improvement in functional outcome remains low, and mortality remains high, but with a much better outcome than leaving the disease untreated.
Disclosures A. Sweid: None. K. Hafazalla: None. S. Tjoumakaris: None. V. Xu: None. K. Shivashankar: None. T. Alexander: None. M. Gooch: None. N. Herial: None. N. Chalouhi: None. R. Rosenwasser: None. P. Jabbour: None.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.