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Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis.

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Title: Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis.
Authors: Berberich, Anne (AUTHOR), Finitsis, Stephanos (AUTHOR), Strambo, Davide (AUTHOR), Michel, Patrik (AUTHOR), Herweh, Christian (AUTHOR), Meyer, Lukas (AUTHOR), Hanning, Uta (AUTHOR), Strbian, Daniel (AUTHOR), Abdalkader, Mohamad (AUTHOR), Nogueira, Raul G. (AUTHOR), Puetz, Volker (AUTHOR), Kaiser, Daniel P. O. (AUTHOR), Olive‐Gadea, Marta (AUTHOR), Ribo, Marc (AUTHOR), Fragata, Isabel (AUTHOR), Marto, João Pedro (AUTHOR), Romoli, Michele (AUTHOR), Ringleb, Peter A. (AUTHOR), Nguyen, Thanh N. (AUTHOR), Nagel, Simon (AUTHOR)
Source: European Journal of Neurology. Sep2022, Vol. 29 Issue 9, p2664-2673. 10p.
Subjects: Posterior cerebral artery, Endovascular surgery, Thrombolytic therapy, Ship trials, Intracranial hemorrhage
Abstract: Background and purpose: Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study‐level meta‐analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods: We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0–2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results: Twelve studies with a total of 679 patients were included in the meta‐analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83–70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35–55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30–20.93) and 12.3% (95% CI 8.64–17.33). sICH occurred in 4.2% (95% CI 2.47–7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75–5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions: Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Group: Ti
  Data: Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and meta‐analysis.
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  Data: <searchLink fieldCode="AR" term="%22Berberich%2C+Anne%22">Berberich, Anne</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Finitsis%2C+Stephanos%22">Finitsis, Stephanos</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Strambo%2C+Davide%22">Strambo, Davide</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Michel%2C+Patrik%22">Michel, Patrik</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Herweh%2C+Christian%22">Herweh, Christian</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Meyer%2C+Lukas%22">Meyer, Lukas</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hanning%2C+Uta%22">Hanning, Uta</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Strbian%2C+Daniel%22">Strbian, Daniel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Abdalkader%2C+Mohamad%22">Abdalkader, Mohamad</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nogueira%2C+Raul+G%2E%22">Nogueira, Raul G.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Puetz%2C+Volker%22">Puetz, Volker</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kaiser%2C+Daniel+P%2E+O%2E%22">Kaiser, Daniel P. O.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Olive‐Gadea%2C+Marta%22">Olive‐Gadea, Marta</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ribo%2C+Marc%22">Ribo, Marc</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fragata%2C+Isabel%22">Fragata, Isabel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Marto%2C+João+Pedro%22">Marto, João Pedro</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Romoli%2C+Michele%22">Romoli, Michele</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ringleb%2C+Peter+A%2E%22">Ringleb, Peter A.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nguyen%2C+Thanh+N%2E%22">Nguyen, Thanh N.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nagel%2C+Simon%22">Nagel, Simon</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Sep2022, Vol. 29 Issue 9, p2664-2673. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Posterior+cerebral+artery%22">Posterior cerebral artery</searchLink><br /><searchLink fieldCode="DE" term="%22Endovascular+surgery%22">Endovascular surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Thrombolytic+therapy%22">Thrombolytic therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Ship+trials%22">Ship trials</searchLink><br /><searchLink fieldCode="DE" term="%22Intracranial+hemorrhage%22">Intracranial hemorrhage</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and purpose: Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study‐level meta‐analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods: We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0–2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results: Twelve studies with a total of 679 patients were included in the meta‐analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83–70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35–55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30–20.93) and 12.3% (95% CI 8.64–17.33). sICH occurred in 4.2% (95% CI 2.47–7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75–5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions: Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/ene.15410
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