TY - JOUR
T1 - Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry
AU - Brouwer, Josje
AU - Ergezen, Saliha
AU - Mulder, Maxim Johan Heymen Laurence
AU - Nijeholt, Geert J.Lycklama A.
AU - Van Es, Adriaan C.G.M.
AU - Van Der Lugt, Aad
AU - Dippel, Diederik W.J.
AU - Majoie, Charles B.L.M.
AU - Roos, Yvo B.W.E.M.
AU - Coutinho, J. M.
AU - Emmer, Bart J.
AU - Van Oostenbrugge, Robert J.
AU - Van Zwam, Wim H.
AU - Boiten, Jelis
AU - Vos, Jan Albert
AU - Jansen, Ivo G.H.
AU - Goldhoorn, Robert Jan B.
AU - Compagne, Kars C.J.
AU - Kappelhof, Manon
AU - Den Hartog, Sanne J.
AU - Hinsenveld, Wouter H.
AU - Roozenbeek, Bob
AU - Schonewille, Wouter J.
AU - Wermer, Marieke J.H.
AU - Van Walderveen, Marianne A.A.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M.
AU - De Bruijn, Sebastiaan F.
AU - Van Dijk, Lukas C.
AU - Van Der Worp, H. Bart
AU - Lo, Rob H.
AU - Van Dijk, Ewoud J.
AU - Boogaarts, Hieronymus D.
AU - De Vries, J.
AU - De Kort, Paul L.M.
AU - Van Tuijl, Julia
AU - Peluso, Jo P.
AU - Fransen, Puck
AU - Van Den Berg, Jan S.P.
AU - Van Hasselt, Boudewijn A.A.M.
AU - Aerden, Leo A.M.
AU - Dallinga, René J.
AU - Uyttenboogaart, Maarten
AU - Eschgi, Omid
AU - Bokkers, Reinoud P.H.
AU - Schreuder, Tobien H.C.M.L.
AU - Postma, Alida A.
AU - Van Der Leij, Christiaan
AU - Brans, Rutger
AU - Pirson, Anne-France
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
CBLMM and YBWEMR received funds from the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie - TWIN) Foundation (related to this project, paid to institution). CBLMM received funds from CVON/Dutch Heart Foundation, Stryker, European Commission, Health Evaluation Netherlands (unrelated; all paid to institution). DWJD and AvdL received research grants from Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organisation for Health Research and Development and Health Holland Top Sector Life Sciences and Health, and unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3, Medac Gmbh/Lamepro, Penumbra Inc, Stryker, Top Medical/Concentric, Thrombolytic Science LLC, Stryker European Operations BV and Cerenovus. YBWEMR and CBLMM are shareholders of Nico.laboratory. CBLMM, YBWEMR, and JMC were principal investigators of the MR CLEAN NO IV trial. DWJD and AvdL were principal investigators of the MR CLEAN MED trial. JMC reports grants from Medtronic, Boehringer Ingelheim, and Bayer outside the submitted work.
Funding Information:
The MR CLEAN Registry was funded and carried out by the Erasmus University Medical Centre, Amsterdam University Medical Centers, location AMC, and Maastricht University Medical Centre. The study was additionally funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie[TWIN]).
Publisher Copyright:
© Author(s).
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit. Objective To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (?NIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications. Results Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred. Conclusions EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
AB - Background Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit. Objective To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (?NIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications. Results Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred. Conclusions EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
U2 - 10.1136/neurintsurg-2021-018505
DO - 10.1136/neurintsurg-2021-018505
M3 - Article
SN - 1759-8478
VL - 15
SP - 363
EP - 369
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
IS - 4
ER -