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Endovascular treatment of acute ischemic stroke in the posterior circulation.

Journal article
Authors Alexandros Rentzos
Jan-Erik Karlsson
Christer Lundqvist
Lars Rosengren
Mikael Hellström
Gunnar Wikholm
Published in Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
Volume 24
Issue 4
ISSN 2385-2011
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Institute of Clinical Sciences, Department of Radiology
Language en
Links dx.doi.org/10.1177/1591019918762320
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Neurology, Radiology, Nuclear Medicine and Medical Imaging

Abstract

Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included. Recanalization rate according to modified Treatment in Cerebral Ischemia score and neurological outcome at three months according to modified Rankin Scale were the main outcomes. Collateral circulation, procedural complications and radiological outcome were evaluated in the radiological examinations. Results The median National Institutes of Health Stroke Scale was 31 (IQR: 13-31) and median time from symptom onset to groin puncture was 300 (IQR: 175-463) minutes. Successful recanalization was seen in 80 of 110 patients (73%). Favorable outcome (modified Rankin Scale ≤2) was seen in 38 patients (35%) while moderate favorable outcome (≤3) was seen in 48 patients (44%). Symptomatic intracerebral hemorrhage occurred in 10 patients (9%). An association between collateral circulation, recanalization rate and outcome was seen. Conclusion Endovascular treatment for posterior circulation stroke in this single-center cohort is relatively safe and effective with decreased mortality and increased favorable outcome compared to natural history.

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