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  • Title: Mechanical Thrombectomy for Anterior versus Posterior Circulation Large Vessel Occlusion Stroke with Emphasis on Posterior Circulation Outcomes.
    Author: Hendrix P, Killer-Oberpfalzer M, Broussalis E, Melamed I, Sharma V, Mutzenbach S, Pikija S, Collins M, Lieberman N, Hecker C, Goren O, Zand R, Schirmer CM, Trinka E, Griessenauer CJ.
    Journal: World Neurosurg; 2022 Feb; 158():e416-e422. PubMed ID: 34763103.
    Abstract:
    PURPOSE: Although there is class I evidence for mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) stroke, no high-class evidence exists for the posterior circulation. Here, we sought to compare clinical features of anterior versus posterior LVO as well as predictors of a posterior LVO MT outcome. METHODS: Patients with acute ischemic stroke who underwent MT for anterior and posterior LVO stroke between February 2016 and August 2020 from 2 comprehensive stroke centers were reviewed. Anterior and posterior LVO strokes were compared. In addition, predictors for a favorable outcome (modified Rankin scale [mRS] 0-3), death (mRS 6), and futile revascularization (mRS 4-6 despite TICI 2b/3 revascularization) for posterior LVO were analyzed. RESULTS: Collectively, 813 LVO thrombectomy cases were analyzed, and 77 of 813 cases (9.5%) were located in the posterior circulation. Although favorable 90-day functional outcome rates did not differ between anterior and posterior LVO (P = 0.093), death was significantly more frequent among posterior LVO cases (P = 0.013). In the posterior LVO subgroup, a primary aspiration technique and successful revascularization TICI 2b/3 irrespective of time to the intervention were independently associated with achieving a favorable outcome. Primary aspiration was identified to inversely associate with futile revascularization. CONCLUSION: Anterior and posterior circulation MT patients have distinct clinical profiles. The use of primary aspiration appears fundamental for beneficial outcomes in posterior circulation MT.
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