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Mechanical thrombectomy for acute posterior cerebral artery stroke; Feasibility and predictors of outcome

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The territorial involvement and the clinical benefit of endovascular therapy (EVT) of the posterior cerebral artery (PCA) occlusion may vary between patients. The purpose of this study was to investigate the feasibility of mechanical thrombectomy (MT) in isolated posterior cerebral artery occlusions (IPCAOs) and the prognostic factors of EVT.

Methods

Forty-eight patients with acute PCA occlusion who underwent EVT between Mar 2008 and Apr 2021 from 2 tertiary centers were retrospectively analyzed. Clinical characteristics, imaging and perfusion abnormalities, and angiographic and clinical outcomes were analyzed. Ischemic changes were assessed with the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS). Perfusion abnormalities were assessed using automated software for Tmax volume measurement and identification of Tmax involved in PCA eloquent areas.

Results

The IPCAO sites were P1 (n = 17) and P2 (n = 31). Overall successful recanalization (mTICI 2b/3) was achieved in 68.8% (33/48) and excellent outcome (90-day mRS 0–1) in 52.1% (25/48) of the patients. Excellent/non-excellent outcome was associated with male sex (p = 0.036), admission NIHSS (p = 0.002), pc-ASPECTS (p = 0.035), Tmax > 6 s involvement of the midbrain-thalamus (p = 0.008), first-line stent-retriever thrombectomy (p = 0.036), complete recanalization (p = 0.009), and modified first pass effect (FPE, p = 0.047). Tmax>6 s involvement of the midbrain-thalamus was an independent predictor for non-excellent outcome on multivariable analysis.

Conclusion

Acute stroke from IPCAO may be successfully treated with EVT. Tmax > 6 s involvement of the midbrain-thalamus on perfusion imaging may be a predictor for clinical outcome.

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Abbreviations

IPCAOs:

Isolated posterior cerebral artery occlusions

EVT:

Endovascular therapy

MT:

Mechanical thrombectomy

AIS:

Acute ischemic stroke

pc-ASPECTS:

posterior circulation Acute Stroke Prognosis Early Computed Tomography Score

NCCT:

Noncontrast CT

CTP:

CT perfusion

MRP:

MR perfusion

SR:

Stent retriever

CA:

Contact aspiration

FPE:

First pass effect

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Sung Hyun Baik & Cheolkyu Jung

  2. Department of Radiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea

    Byung Moon Kim & Dong Joon Kim

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  1. Sung Hyun Baik
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  2. Cheolkyu Jung
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Correspondence to Dong Joon Kim.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was conducted with the approval of the institutional review boards.

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Baik, S.H., Jung, C., Kim, B.M. et al. Mechanical thrombectomy for acute posterior cerebral artery stroke; Feasibility and predictors of outcome. Neuroradiology 64, 1419–1427 (2022). https://doi.org/10.1007/s00234-022-02910-3

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