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At present, there is little clinical evidence for the potential efficacy of mechanical thrombectomy in the treatment of DMVO stroke.
Therefore, Lukas Meyer and other scholars from Germany conducted a study to explore the frequency and clinical and safety results of mechanical thrombectomy for isolated posterior circulation DMVO stroke, and compare it with the presence or absence of intravenous thrombolysis.
(IVT) standard drug treatment results are compared.
The research results were published in the recent JAMA Neurology.
Yimaitong compiles and compiles, please do not reprint without authorization.
Study Introduction This multicenter case-control study analyzed patients who received primary distal occlusion of the P2 or P3 posterior cerebral artery (PCA).
Between January 1, 2010 and June 30, 2020, these patients received mechanical thrombectomy or standard medical treatment (with or No IVT).
All patients meeting the inclusion criteria were matched with 1:1 propensity score matching method.
The main clinical endpoint is the improvement of the National Institutes of Health Stroke Scale (NIHSS) score at discharge.
The safety endpoint is the occurrence of symptomatic intracranial hemorrhage.
The functional outcome was the modified Rankin Scale (mRS) score at 90 days.
Research results ➤ Basic situation Among the 243 patients who met the inclusion criteria in all participating centers, 184 patients were finally included.
The median age (interquartile range [IQR]) of these patients was 74 (62-81) years, and 95 cases (51.
6%) were women; 149 cases (81.
0%) had posterior circulation DMVO in the P2 segment of PCA, 35 cases (19.
0%) is in the P3 segment.➤ Clinical and functional endpoints (1) At discharge, the average NIHSS score of the standard drug treatment group was reduced to -2.
4 points (95% CI: -3.
2 to -1.
6), and the average NIHSS score of the mechanical thrombectomy group was reduced to -3.
9 Points (95%CI: -5.
4~-2.
5), the average difference is -1.
5 points (95%CI: 3.
2~-0.
8; P=0.
06).
(2) The subgroup of patients with NIHSS score ≥10 at the time of admission (mean difference: -5.
6; 95% CI: -10.
9~-0.
2; P=0.
04) and the subgroup of patients without IVT (mean difference: -3.
0; 95% CI: -5.
0~-0.
9; P=0.
005), a significant therapeutic effect of mechanical thrombectomy was observed.
(3) During the 90-day follow-up, 51 (66.
2%) of 77 patients in the mechanical thrombectomy group and 31 (54.
4%) of 57 patients in the standard medical treatment group observed good results.
Functional outcome (mRS≤1).
Overall, there was no significant difference in the distribution of mRS scores between the two groups during the 90-day follow-up (P = 0.
26) (see Figure 1).
Figure 1 90-day modified Rankin Scale (mRS) score ➤ The safety endpoint endovascular treatment complications included 4 out of 92 patients in each group (4.
3%) with symptomatic cerebral hemorrhage.
There was no significant difference in mortality between the mechanical thrombectomy group and the standard medical treatment group.
Conclusion In this case-control study, compared with standard medical treatment, mechanical thrombectomy seems to be reasonable, safe and technically feasible for patients with primary posterior circulation DMVO stroke P2 or P3 occlusion, especially When the patient is unable to use IVT treatment or shows a high NIHSS score (≥10 points).
The results of the study do not agree with general treatment recommendations.
Therefore, conducting a large-scale randomized controlled trial comparing mechanical thrombectomy with standard drug therapy will help evaluate the application of thrombectomy in DMVO in the posterior circulation and help solve the problem of clinical balance in acute treatment decision-making.
. Yimaitong compiled from: Meyer L, Stracke CP, Jungi N, et al.
Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study.
JAMA Neurol.
Published online February 22, 2021.
doi:10.
1001/jamaneurol.
2021.
0001.
Therefore, Lukas Meyer and other scholars from Germany conducted a study to explore the frequency and clinical and safety results of mechanical thrombectomy for isolated posterior circulation DMVO stroke, and compare it with the presence or absence of intravenous thrombolysis.
(IVT) standard drug treatment results are compared.
The research results were published in the recent JAMA Neurology.
Yimaitong compiles and compiles, please do not reprint without authorization.
Study Introduction This multicenter case-control study analyzed patients who received primary distal occlusion of the P2 or P3 posterior cerebral artery (PCA).
Between January 1, 2010 and June 30, 2020, these patients received mechanical thrombectomy or standard medical treatment (with or No IVT).
All patients meeting the inclusion criteria were matched with 1:1 propensity score matching method.
The main clinical endpoint is the improvement of the National Institutes of Health Stroke Scale (NIHSS) score at discharge.
The safety endpoint is the occurrence of symptomatic intracranial hemorrhage.
The functional outcome was the modified Rankin Scale (mRS) score at 90 days.
Research results ➤ Basic situation Among the 243 patients who met the inclusion criteria in all participating centers, 184 patients were finally included.
The median age (interquartile range [IQR]) of these patients was 74 (62-81) years, and 95 cases (51.
6%) were women; 149 cases (81.
0%) had posterior circulation DMVO in the P2 segment of PCA, 35 cases (19.
0%) is in the P3 segment.➤ Clinical and functional endpoints (1) At discharge, the average NIHSS score of the standard drug treatment group was reduced to -2.
4 points (95% CI: -3.
2 to -1.
6), and the average NIHSS score of the mechanical thrombectomy group was reduced to -3.
9 Points (95%CI: -5.
4~-2.
5), the average difference is -1.
5 points (95%CI: 3.
2~-0.
8; P=0.
06).
(2) The subgroup of patients with NIHSS score ≥10 at the time of admission (mean difference: -5.
6; 95% CI: -10.
9~-0.
2; P=0.
04) and the subgroup of patients without IVT (mean difference: -3.
0; 95% CI: -5.
0~-0.
9; P=0.
005), a significant therapeutic effect of mechanical thrombectomy was observed.
(3) During the 90-day follow-up, 51 (66.
2%) of 77 patients in the mechanical thrombectomy group and 31 (54.
4%) of 57 patients in the standard medical treatment group observed good results.
Functional outcome (mRS≤1).
Overall, there was no significant difference in the distribution of mRS scores between the two groups during the 90-day follow-up (P = 0.
26) (see Figure 1).
Figure 1 90-day modified Rankin Scale (mRS) score ➤ The safety endpoint endovascular treatment complications included 4 out of 92 patients in each group (4.
3%) with symptomatic cerebral hemorrhage.
There was no significant difference in mortality between the mechanical thrombectomy group and the standard medical treatment group.
Conclusion In this case-control study, compared with standard medical treatment, mechanical thrombectomy seems to be reasonable, safe and technically feasible for patients with primary posterior circulation DMVO stroke P2 or P3 occlusion, especially When the patient is unable to use IVT treatment or shows a high NIHSS score (≥10 points).
The results of the study do not agree with general treatment recommendations.
Therefore, conducting a large-scale randomized controlled trial comparing mechanical thrombectomy with standard drug therapy will help evaluate the application of thrombectomy in DMVO in the posterior circulation and help solve the problem of clinical balance in acute treatment decision-making.
. Yimaitong compiled from: Meyer L, Stracke CP, Jungi N, et al.
Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study.
JAMA Neurol.
Published online February 22, 2021.
doi:10.
1001/jamaneurol.
2021.
0001.
