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Meta-Analysis
. 2023 Jun;33(2):405-414.
doi: 10.1007/s00062-022-01221-7. Epub 2022 Oct 20.

Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion : Systematic Review and Meta-analysis

Ramy Abdelnaby  1 , Khaled Ashraf Mohamed  2 , Anas ELgenidy  2 , Yousef Tarek Sonbol  2 , Mahmoud Mostafa Bedewy  2 , Aya Moustafa Aboutaleb  3 , Khaled Tarek Dardeer  2 , Hamed Amr Heikal  2 , Hazem Maher Gawish  2 , Omid Nikoubashman  4 , Arno Reich  1 , João Pinho  5
Affiliations
Meta-Analysis

Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion : Systematic Review and Meta-analysis

Ramy Abdelnaby et al. Clin Neuroradiol. 2023 Jun.

Abstract

Purpose: Patients with isolated posterior cerebral artery occlusion (iPCAO) represent up to 6% of all acute ischemic stroke patients. Acute revascularization therapies for these patients were not tested in randomized controlled trials. The aim of this study was to evaluate outcomes of iPCAO patients who undergo endovascular treatment (EVT).

Methods: A systematic search of MEDLINE, Web of Science, CENTRAL, Scopus (inception-03/2022) was conducted for studies reporting 3‑month outcome, symptomatic intracranial hemorrhage (sICH) and/or successful recanalization in iPCAO patients who underwent EVT. Random effect meta-analyses for pooled proportions were calculated. Double-arm meta-analyses for comparison of outcomes of iPCAO patients treated with EVT with age-, sex- and NIHSS-matched iPCAO patients treated with best medical treatment only were performed.

Results: Fifteen studies reporting a total of 461 iPCAO patients who underwent EVT were included. Excellent and favorable 3‑month outcome proportions were 36% (95% confidence interval, CI 20-51%) and 57% (95% CI 40-73%), respectively. The 3‑month mortality was 9% (95% CI 5-13), sICH occurred in 1% (95% CI 0-2%), successful recanalization was achieved in 79% (95% CI 71-86%). No significant differences in favorable and excellent 3‑month outcomes, 3‑month mortality and symptomatic intracerebral hemorrhage were found between the groups of patients who underwent EVT and the group of patients who received best medical treatment only.

Conclusion: These results support the feasibility and safety of EVT in iPCAO, but do not show an outcome benefit with EVT compared to best medical treatment. Randomized trials are needed to evaluate treatment benefit of EVT in these patients.

Keywords: Ischemic stroke; Large vessel occlusion; Outcome; Stroke; Thrombectomy.

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Conflict of interest statement

R. Abdelnaby, K.A. Mohamed, A. ELgenidy, Y.T. Sonbol, M.M. Bedewy, A.M. Aboutaleb, K.T. Dardeer, H.A. Heikal, H.M. Gawish, O. Nikoubashman, A. Reich and J. Pinho declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart summarizing literature search strategy. PCA posterior cerebral artery
Fig. 2
Fig. 2
Forest plots of the random effects meta-analysis for outcomes of patients with isolated posterior cerebral artery occlusion who received endovascular therapy: a excellent outcome; b favourable outcome; c mortality; d symptomatic intracranial hemorrhage; e successful reperfusion; f mean National Institutes of Health Stroke Scale change. ICH intracranial hemorrhage, TICI modified treatment in cerebral ischemia score, NIHSS National Institutes of Health Stroke Scale, 95% CI 95% confidence interval
Fig. 3
Fig. 3
Forest plots of the random effects meta-analysis comparing patients with isolated posterior cerebral artery occlusion who underwent endovascular treatment with age-, sex- and NIHSS-matched patients who received best medical treatment only: a excellent outcome; b favourable outcome; c mortality; d symptomatic intracranial hemorrhage. ICH intracranial hemorrhage, EVT endovascular treatment, BMT best medical treatment, RR risk ratio, 95% CI 95% confidence interval
See this image and copyright information in PMC

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