Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta-analysis

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Anne Berberich - , Universität Heidelberg (Autor:in)
  • Stephanos Finitsis - , Aristotle University of Thessaloniki (Autor:in)
  • Davide Strambo - , Université de Lausanne (Autor:in)
  • Patrik Michel - , Université de Lausanne (Autor:in)
  • Christian Herweh - , Universität Heidelberg (Autor:in)
  • Lukas Meyer - , Universität Hamburg (Autor:in)
  • Uta Hanning - , Universität Hamburg (Autor:in)
  • Daniel Strbian - , University of Helsinki (Autor:in)
  • Mohamad Abdalkader - , Boston University (Autor:in)
  • Raul G. Nogueira - , University of Pittsburgh (Autor:in)
  • Volker Puetz - , Klinik und Poliklinik für Neurologie, Dresdner NeurovaskuläresCentrum, Technische Universität Dresden (Autor:in)
  • Daniel P.O. Kaiser - , Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie, Dresdner NeurovaskuläresCentrum, Technische Universität Dresden (Autor:in)
  • Marta Olive-Gadea - , Autonomous University of Barcelona (Autor:in)
  • Marc Ribo - , Autonomous University of Barcelona (Autor:in)
  • Isabel Fragata - , Universidade de Lisboa (Autor:in)
  • João Pedro Marto - , Santa Cruz Hospital (Autor:in)
  • Michele Romoli - , Ospedale M. Bufalini (Autor:in)
  • Peter A. Ringleb - , Universität Heidelberg (Autor:in)
  • Thanh N. Nguyen - , Boston University (Autor:in)
  • Simon Nagel - , Universität Heidelberg, Klinikum Ludwigshafen (Autor:in)

Abstract

BACKGROUND AND PURPOSE: Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study-level meta-analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke.

METHODS: We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0-2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH).

RESULTS: Twelve studies with a total of 679 patients were included in the meta-analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83-70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35-55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30-20.93) and 12.3% (95% CI 8.64-17.33). sICH occurred in 4.2% (95% CI 2.47-7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75-5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences.

CONCLUSIONS: Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.

Details

OriginalspracheEnglisch
Seiten (von - bis)2664-2673
Seitenumfang10
FachzeitschriftEuropean journal of neurology
Jahrgang29
Ausgabenummer9
PublikationsstatusVeröffentlicht - Sept. 2022
Peer-Review-StatusJa

Externe IDs

PubMed 35587104
ORCID /0000-0001-5258-0025/work/146644934

Schlagworte

ASJC Scopus Sachgebiete

Schlagwörter

  • distal vessel occlusion, endovascular therapy, intravenous thrombolysis, posterior cerebral artery occlusion, stroke

Bibliotheksschlagworte