Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study - Pharmacologie et Pathologies Fragilisantes (PPF)
Article Dans Une Revue Stroke Année : 2023

Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study

1 Fondation Ophtalmologique Adolphe de Rotschild
2 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
3 UNIL - Université de Lausanne = University of Lausanne
4 UNIBE - Universität Bern = University of Bern = Université de Berne
5 Inselspital - Bern University Hospital [Berne]
6 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
7 HCL - Hospices Civils de Lyon
8 Hôpital Gui de Chauliac [CHU Montpellier]
9 LilNCog - Lille Neurosciences & Cognition - U 1172
10 GHU Paris Psychiatrie et Neurosciences
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
12 UGA - Université Grenoble Alpes
13 GIN - [GIN] Grenoble Institut des Neurosciences
14 UB - Université de Bordeaux
15 UNISTRA - Université de Strasbourg
16 Centre Hospitalier Saint Jean de Perpignan
17 CHU Pitié-Salpêtrière [AP-HP]
18 Tanta University
19 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
20 CHV - Centre Hospitalier de Versailles André Mignot
21 CHU Reims - Hôpital universitaire Robert Debré [Reims]
22 HERVI - EA 3801 - Hémostase et Remodelage Vasculaire Post-Ischémie
23 Hôpital Foch [Suresnes]
24 CHU Rouen
25 Service de Chirurgie Cardio-vasculaire [CHRU Nancy]
26 CHRO - Centre Hospitalier Régional d'Orléans
27 Centre Hospitalier Métropole Savoie [Chambéry]
28 Centre Hospitalier René Dubos [Pontoise]
29 PEC2 - Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon]
30 Department of Neurology [Genève]
31 Service de Neurologie [CHU de Saint-Étienne]
32 RESHAPE - Inserm U1290 - UCBL1 - Research on Healthcare Performance
33 MYRIAD - Modeling & analysis for medical imaging and Diagnosis
34 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
35 Neuroradiologie [Hôpital Gui de Chauliac]
36 Stanford University
37 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
38 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
39 Hôpital Lariboisière-Fernand-Widal [APHP]
40 GHU-PPN - FHU NeuroVasc [Site Sainte-Anne, Paris]
41 Hôpital Sainte-Anne [Paris]
42 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
I. Sibon
  • Fonction : Auteur
A. Triquenot-Bagan
  • Fonction : Auteur
G. W. Albers
  • Fonction : Auteur

Résumé

BACKGROUND: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown. METHODS: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0-2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0-1), symptomatic intracranial hemorrhage, and early neurological deterioration. RESULTS: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63-82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4-10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66-1.01]; P=0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95-1.43]; P=0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35-4.67]; P=0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64-3.84]; P\textless0.0001). CONCLUSIONS: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.
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Dates et versions

inserm-04314014 , version 1 (29-11-2023)

Identifiants

Citer

C. Sabben, F. Charbonneau, F. Delvoye, D. Strambo, M. R. Heldner, et al.. Endovascular Therapy or Medical Management Alone for Isolated Posterior Cerebral Artery Occlusion: A Multicenter Study. Stroke, 2023, 54 (4), pp.928-937. ⟨10.1161/strokeaha.122.042283⟩. ⟨inserm-04314014⟩
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