Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Thanh N. Nguyen - , Boston University (Author)
  • Muhammad M. Qureshi - , Boston University (Author)
  • Davide Strambo - , University of Lausanne (Author)
  • Daniel Strbian - , University of Helsinki (Author)
  • Silja Räty - , University of Helsinki (Author)
  • Christian Herweh - , Heidelberg University  (Author)
  • Mohamad Abdalkader - , Boston University (Author)
  • Marta Olive-Gadea - , Autonomous University of Barcelona (Author)
  • Marc Ribo - , Autonomous University of Barcelona (Author)
  • Marios Psychogios - , University of Basel (Author)
  • Urs Fischer - , University of Basel (Author)
  • Anh Nguyen - , University of Basel (Author)
  • Joji B. Kuramatsu - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • David Haupenthal - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Martin Köhrmann - , University of Duisburg-Essen (Author)
  • Cornelius Deuschl - , University of Duisburg-Essen (Author)
  • Jordi Kühne Escola - , University of Duisburg-Essen (Author)
  • Shadi Yaghi - , Brown University (Author)
  • Liqi Shu - , Brown University (Author)
  • Volker Puetz - , Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav Carus Dresden (Author)
  • Daniel P.O. Kaiser - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus Dresden (Author)
  • Johannes Kaesmacher - , University of Bern (Author)
  • Adnan Mujanovic - , Grady Health System (Author)
  • Dominique Cornelius Marterstock - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Tobias Engelhorn - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Piers Klein - , Boston University (Author)
  • Diogo C. Haussen - , Grady Health System (Author)
  • Mahmoud H. Mohammaden - , Grady Health System (Author)
  • Hend Abdelhamid - , Grady Health System (Author)
  • Lorena Souza Viana - , Grady Health System (Author)
  • Bruno Cunha - , Centro Hospitalar Universitario de Lisboa Central (Author)
  • Isabel Fragata - , Centro Hospitalar Universitario de Lisboa Central (Author)
  • Michele Romoli - , Ospedale M. Bufalini, University of Helsinki (Author)
  • Francesco Diana - , Autonomous University of Barcelona (Author)
  • Pekka Virtanen - , University of Helsinki (Author)
  • Kimmo Lappalainen - , University of Helsinki (Author)
  • Judith Clark - , Boston University (Author)
  • Stavros Matsoukas - , Mount Sinai Hospital Medical Center (Author)
  • Johanna T. Fifi - , Mount Sinai Hospital Medical Center (Author)
  • Sunil A. Sheth - , University of Texas Health Science Center at Houston (Author)
  • Sergio Salazar-Marioni - , University of Texas Health Science Center at Houston (Author)
  • João Pedro Marto - , Santa Cruz Hospital (Author)
  • João Nuno Ramos - , Santa Cruz Hospital (Author)
  • Milena Miszczuk - , Free University of Berlin (Author)
  • Christoph Riegler - , Free University of Berlin (Author)
  • Ashutosh P. Jadhav - , St. Joseph's Hospital and Medical Center, Phoenix (Author)
  • Shashvat M. Desai - , St. Joseph's Hospital and Medical Center, Phoenix (Author)
  • Volker Maus - , Ruhr University Bochum (Author)
  • Maximilian Kaeder - , Ruhr University Bochum (Author)
  • Adnan H. Siddiqui - , State University of New York (SUNY) at Buffalo (Author)
  • Andre Monteiro - , State University of New York (SUNY) at Buffalo (Author)
  • Hesham E. Masoud - , SUNY Upstate Medical University (Author)
  • Neil Suryadevara - , University of Pittsburgh (Author)
  • Maxim Mokin - , University of South Florida (Author)
  • Shail Thanki - , University of South Florida (Author)
  • James E. Siegler - , Cooper University Hospital (Author)
  • Jane Khalife - , Cooper University Hospital (Author)
  • Italo Linfante - , Miami Neuroscience Institute (Author)
  • Guilherme Dabus - , Miami Neuroscience Institute (Author)
  • Negar Asdaghi - , University of Miami (Author)
  • Vasu Saini - , University of Miami (Author)
  • Christian H. Nolte - , Free University of Berlin (Author)
  • Eberhard Siebert - , Free University of Berlin (Author)
  • Thomas R. Meinel - , University of Bern (Author)
  • Stefanos Finitsis - , Aristotle University of Thessaloniki (Author)
  • Markus A. Möhlenbruch - , Heidelberg University  (Author)
  • Peter A. Ringleb - , Heidelberg University  (Author)
  • Anne Berberich - , Klinikum Ludwigshafen (Author)
  • Raul G. Nogueira - , University of Pittsburgh (Author)
  • Uta Hanning - , University of Hamburg (Author)
  • Lukas Meyer - , University of Hamburg (Author)
  • Patrik Michel - , University of Lausanne (Author)
  • Simon Nagel - , Heidelberg University  (Author)

Abstract

BACKGROUND: The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion.

METHODS: This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale.

RESULTS: Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002).

CONCLUSIONS: In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

Details

Original languageEnglish
Pages (from-to)1708-1717
Number of pages10
JournalStroke
Volume54
Issue number7
Publication statusPublished - 1 Jul 2023
Peer-reviewedYes

External IDs

PubMed 37222709
ORCID /0000-0001-5258-0025/work/146644925

Keywords

Keywords

  • case-control studies, cerebrovascular disorders, logistic models, posterior cerebral artery, stroke, thrombectomy, thrombolytic therapy, Stroke, Posterior Cerebral Artery/diagnostic imaging, Humans, Endovascular Procedures/adverse effects, Male, Treatment Outcome, Case-Control Studies, Thrombectomy, Aged, 80 and over, Female, Aged, Brain Ischemia/therapy, Intracranial Hemorrhages/etiology