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Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions

Abstract

Purpose

Mechanical thrombectomy (MT) in posterior circulation large vessel occlusion (LVO), including posterior cerebral artery (PCA), has not been validated since all five major MT trials excluded such patients. To evaluate the feasibility and preliminary safety and efficacy of MT in isolated PCA occlusion stroke patients with new-generation MT devices.

Methods

Endovascularly treated acute ischemic stroke (AIS) patients were identified from a prospectively collected database and their baseline characteristics were noted. Clinical outcomes were angiographic recanalization, a favorable clinical outcome at 3 months on modified Rankin Scale (mRS) and visual field (VF) deficit improvement on confrontation test, rate of intracranial hemorrhage (ICH), and mortality at 3 months.

Results

A total of 355 AIS patients underwent MT from January 2018 to December 2019. Isolated PCA MT was performed in 15 consecutive patients. The mean age was 64 ± 17 years, and 9(60%) were women. Median presentation NIHSS was 9 (interquartile range 5–15). MT devices used were stent retrievers in 6 patients and combined aspiration and stent retriever in 9 patients. Complete revascularization (TICI 2c or 3) was achieved in 12/15 patients. 3-month VF normalization was seen in 7/12 of the patients. Post-procedure symptomatic ICH occurred in 1/15 of patients. mRS score of 0–2 was achieved in 9/15 of patients but one patient was dead at 3 months post procedure.

Conclusion

MT is feasible and can achieve successful reperfusion in isolated PCA occlusions and resulted in favorable motor and visual outcomes in this small series of ischemic stroke patients.

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Funding

No funding was received for this study.

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Correspondence to Muhammad Zeeshan Memon.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the 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.

Informed consent

This study involves retrospectively collected data of patients undergoing mechanical thrombectomy as per standard of care. The study was approved by the institutional review board of the University of Miami and exempted from informed consent as it was a retrospective analysis. All patient data reported in the study were deidentified. Any potential patient identifiers were also removed from the angiographic figures.

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Memon, M.Z., Kushnirsky, M., Brunet, M.C. et al. Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions. Neuroradiology 63, 111–116 (2021). https://doi.org/10.1007/s00234-020-02505-w

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  • DOI: https://doi.org/10.1007/s00234-020-02505-w

Keywords

  • Stroke
  • Mechanical thrombectomy
  • Large vessel occlusion
  • Posterior cerebral artery
  • Visual field outcomes