Endovascular Thrombectomy for Treatment of Isolated Posterior Cerebral Artery Occlusion: A Real-World Analysis of Hospitalizations in the United States

Authors

Alis J. Dicpinigaitis, Department of Neurology, New York Presbyterian - Weill Cornell Medical Center, New York, NY, USA.
Shoaib A. Syed, School of Medicine, New York Medical College, Valhalla, NY, USA.
Jude Al-Mufti, School of Medicine, New York Medical College, Valhalla, NY, USA.
Chaitanya Medicherla, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Macy Pavilion 1331, Valhalla, NY, 10595, USA.
Gurmeen Kaur, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Macy Pavilion 1331, Valhalla, NY, 10595, USA.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Macy Pavilion 1331, Valhalla, NY, 10595, USA.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Macy Pavilion 1331, Valhalla, NY, 10595, USA. Fawaz.Al-Mufti@wmchealth.org.

Author Type(s)

Student, Faculty

Journal Title

Acta Neurochirurgica

First Page

191

Document Type

Article

Publication Date

4-24-2024

Department

Neurosurgery

Second Department

Neurology

Abstract

BACKGROUND: Despite renewed interest and recently demonstrated efficacy for endovascular thrombectomy (EVT) for treatment of acute ischemic stroke (AIS) of the posterior circulation, to date, no randomized clinical trials have been conducted to evaluate EVT for isolated occlusions of the posterior cerebral artery (IPCA). METHODS: Hospitalizations for adult patients with primary admission diagnoses of IPCA occlusion were identified in the National Inpatient Sample registry during the period of 2016-2020. The study exposure was treatment with EVT, and primary clinical endpoints included favorable functional outcome (defined as discharge disposition to home without services, previously shown to have high concordance with modified Rankin scale scores 0-2), in-hospital mortality, and any intracranial hemorrhage (ICH). Inverse probability of treatment weighting (IPTW) was performed to balance baseline clinical characteristics between those receiving EVT or medical management (MM). RESULTS: This analysis identified 34,880 IPCA occlusion hospitalizations, 730 (2.1%) of which documented treatment with EVT. Following IPTW adjustment, EVT was associated with favorable outcome in IPCA patients presenting with mild deficits (M-D) (NIHSS < 6) [adjusted odds ratio (aOR) 2.36, 95% confidence interval (CI) 2.27, 2.45; p < 0.001] and in those presenting with moderate-to-severe deficits (M-S-D) (NIHSS 6-42) (aOR 2.00, 95% CI 1.86, 2.15; p < 0.001). Mortality rates did not differ among those with M-S-D [EVT 4.8% vs. MM 4.7%, p = 0.742], while ICH rates were lower. CONCLUSION: Retrospective analysis of a large administrative registry in the Unites States demonstrates an association of EVT with favorable outcomes following IPCA occlusion, without concomitant risk of hemorrhagic transformation or mortality.

Recommended Citation

Dicpinigaitis, A. J., Syed, S. A., Al-Mufti, J., Medicherla, C., Kaur, G., Gandhi, C. D., & Al-Mufti, F. (2024). Endovascular Thrombectomy for Treatment of Isolated Posterior Cerebral Artery Occlusion: A Real-World Analysis of Hospitalizations in the United States. Acta Neurochirurgica, 166 (1), 191. https://doi.org/10.1007/s00701-024-06050-w