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Meta-Analysis
. 2024 Mar;9(1):69-77.
doi: 10.1177/23969873231201715. Epub 2023 Sep 26.

Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: A systematic review and meta-analysis

Ahmed Alkhiri  1   2 , Aser F Alamri  3   4 , Abdullah R Alharbi  5 , Ahmed A Almaghrabi  1   2 , Nayef Alansari  1   2 , Abdulelah A Niaz  1   2 , Basil A Alghamdi  1   2 , Amrou Sarraj  6 , Adel Alhazzani  7 , Fahad S Al-Ajlan  7   8
Affiliations
Meta-Analysis

Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: A systematic review and meta-analysis

Ahmed Alkhiri et al. Eur Stroke J. 2024 Mar.

Abstract

Background and purpose: Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO.

Methods: We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) using a random-effects model.

Results: Seven studies involving 2560 patients were included. EVT was associated with significantly higher likelihood of early neurological improvement (OR, 2.31 [95% CI, 1.38-2.91]; p < 0.00001) and visual field normalization (OR, 3.08 [95% CI, 1.76-5.38]; p < 0.0001) compared to BMM. Rates of good functional outcomes (mRS 0-2) were comparable between the two arms (OR, 0.88 [95% CI, 0.70-1.10]; p = 0.26). Symptomatic intracranial hemorrhage (sICH) was comparable between the two groups (OR, 1.94 [95% CI, 0.96-3.93]; p = 0.07). Mortality was also similar between the two groups (OR, 1.36; [95% CI, 0.77-2.42]; p = 0.29).

Conclusions: In patients with iPCAO, EVT was associated with visual and early neurological improvement but with a strong trend toward increased sICH. Survival and functional outcomes may be slightly poorer. The role of EVT in iPCAO remains uncertain.

Keywords: Posterior cerebral artery; ischemic stroke; meta-analysis; thrombectomy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram summarizing literature search strategy. PCA: posterior cerebral artery.
Figure 2.
Figure 2.
Rates of early neurological improvements for patient groups treated with either endovascular thrombectomy or best medical management. BMM: best medical management; EVT: endovascular thrombectomy; ENI: early neurological improvement; NIHSS: National Institutes of Health Stroke Scale; CI: confidence interval; IV: inverse variance.
Figure 3.
Figure 3.
Rates for visual field normalization for patient groups treated with either endovascular thrombectomy or best medical management. BMM: best medical management; EVT: endovascular thrombectomy; CI: confidence interval; IV: inverse variance.
Figure 4.
Figure 4.
Forest plots of (a) rates of favorable functional outcome (mRS score of 0–2) at 3 months and (b) rates of excellent functional outcome (mRS score of 0–1) at 3 months. BMM: best medical management; EVT: endovascular thrombectomy; mRS: modified Rankin Scale; CI: confidence interval; IV: inverse variance.
Figure 5.
Figure 5.
Forest plots of (a) symptomatic intracranial hemorrhage rates and (b) mortality rates at 3 months. BMM: best medical management; EVT: endovascular thrombectomy; CI: confidence interval; IV: inverse variance.
See this image and copyright information in PMC

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