Introduction Recent data showed benefit from MT for medium vessel occlusion. Few data are available for isolated posterior cerebral artery (PCA) occlusion stroke. PCA (including P1) is considered a medium vessel for most interventionalists.
Objective The purpose of this systematic review and meta-analysis was to assess all the available evidence on the efficacy and safety of MT techniques for the treatment of isolated PCA occlusion stroke.
Methods We used PRISMA guidelines to report our search results. Searches were conducted using the PubMed/Medline, Scopus, Embase, and Cochrane databases up to October 2022, including randomized clinical trials (RCT) and observational studies that included mechanical thrombectomy for isolated PCA strokes. Our primary outcome was functional independence, defined as modified Rankin Scale score (mRS): 0-2. Secondary outcomes were successful revascularization defined mTICI >=2b, excellent outcome (mRS:0-1), type of device used, 90 days mortality, symptomatic intracranial hemorrhage (sICH) and all ICH. We performed a meta-analysis using the random effect model. Pooled proportions were calculated. A sensitivity analysis based on the MT technique was also performed for all outcomes. We conducted the meta-analyses using random-effects models and assessed the certainty of evidence using the GRADE approach. Statistical heterogeneity across studies was assessed with I2 statistics and accounted for with subgroup and meta-regression analyses.
Results Mechanical thrombectomy alone: Thirteen studies (n=463) showed results of patients who underwent MT. Pooled proportions after random analysis were 54.63% [95% CI: 49.20-59.94]%; I2=16%) for functional independence, 12.18 [95% CI: 7.84-18.42]%; I2=50%) for mortality at 90 days was and 4.15% [95% CI: 2.17-7.80]%; I2=0%) for symptomatic ICH. Excellent outcome (mRS:0-1) was reported in 6 studies with a polled proportion of 39.75% [95% CI: 29.14-51.42]%; I2=65%). Heterogenicity was substantial between studies. Mechanical Thrombectomy versus best Medical Management:Four studies showed a comparison between MT versus best medical management (MM). After random effect analysis patients who underwent MT presented similar chances to achieve functional independence: OR 1.30 [95% CI 0.68-2.46; I2=53% (p=0.09)], 90-days mortality: OR 1.20 [95% CI 0.65-2.21; I2=0% (p=0.87)], and symptomatic ICH: OR 1.64 [95% CI 0.78-3.45; I2=40% (p=0.19)]. Baseline characteristics were similar in both groups.
Conclusion Our results suggest that MT for isolated PCA occlusion stroke is feasible. However, when compared with best medical management there is no difference in functional independence, 90-days mortality or symptomatic ICH. Given the limitations of our results, further confirmation in well-designed RCTs is needed.
Disclosures J. Sequeiros: None. M. Padilla: None. F. Terry: None. M. Cabanillas: None. E. Gaudio: None. H. Zaver: None. C. Alva: None. V. Inoa: None. B. Krishnaiah: None. N. Goyal: 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.