Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management

Candice Sabben¹, Frédérique Charbonneau², Michael Obadia¹, Davide Strambo³, Elodie Ong⁴, Mirjam R Heldner⁵, Hilde Henon⁶, Adrien Ter Schiphorst⁷, Loïc Legris⁸, Thomas Agasse-Lafont⁹, Denis Sablot¹⁰, Nour Nehme¹¹, Igor Sibon¹², Aude Triquenot-Bagan¹³, Valérie Wolff¹⁴, Cécile Preterre¹⁵, Charlotte Rosso¹⁶, Gioia Mione¹⁷, Roxana Poll¹⁸, Jérémie Papassin¹⁹, Andreea Aignatoaie²⁰, David Weisenburger Lile²¹, Yannick Béjot²², Solène Moulin²³, Emmanuel Carrera²⁴, Pierre Garnier²⁵, Patrik Michel³, Pasquale Mordasini²⁶, Gregory W Albers²⁷, Guillaume Turc^{28

29

30}, Mikael Mazighi^{31

32}, Pierre Seners^{1

28

30}; ACAPULCO collaborators

Collaborators, Affiliations

Collaborators

ACAPULCO collaborators:
Frédérique Charbonneau, Francois Delvoye, Michael Obadia, Julien Savatovsky, Mikael Mazighi, Pierre Seners, Davide Strambo, Patrik Michel, Guillaume Saliou, Elodie Ong, Yves Berthezene, Mirjam R Heldner, Pasquale Mordasini, Kateryna Antonenko, Sara Pilgram-Pastor, Martin Zbinden, Hilde Henon, Nicolas Bricout, Adrien Ter Schiphorst, Caroline Arquizan, Vincent Costalat, Loïc Legris, Olivier Detante, Thomas Agasse-Lafont, Clément Tracol, François Eugene, Denis Sablot, Guillaume Turc, Wagih Ben Hassen, Nour Nehme, Fernando Pico, Igor Sibon, Sylvain Ledure, Aude Triquenot-Bagan, Emmanuel Gerardin, Valérie Wolff, Mathieu Krug, Raoul Pop, Stéphane Kremer, Cécile Preterre, Hubert Desal, Andreea Aignatoaie, Canan Ozsancak, Christophe Magni, Charlotte Rosso, Mahmoud Elhorany, Frédéric Clarençon, Sébastien Richard, Benjamin Gory, Gioia Mione, Roxana Poll, Philippe Niclot, Lynda Benammar, Jérémie Papassin, Solène Moulin, Solène Soize, David Weisenburger Lile, Bertrand Lapergue, Yannick Béjot, Pierre-Olivier Comby, Emmanuel Carrera, Pierre Garnier, Claire Boutet, Gregory W Albers

Affiliations

¹ Neurology Department, Rothschild Foundation Hospital, Paris, France.
² Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
³ Stroke Center, Neurology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
⁴ Stroke Department, Hospices Civils de Lyon, Lyon, France.
⁵ Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
⁶ Neurology Department, Stroke Center, University of Lille, Inserm U1171, CHU Lille, LilNCog-Lille Neuroscience & Cognition, Lille, France.
⁷ Neurology Department, CHRU Gui de Chauliac, Montpellier, France.
⁸ Neurology Department, Stroke Unit, Grenoble Alpes University Hospital, University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France.
⁹ Neurology Department, CHU Rennes, Rennes, France.
¹⁰ Neurology Department, CH Perpignan, Perpignan, France.
¹¹ Neurology Department, André Mignot Hospital, Versailles, France.
¹² Stroke Unit, Bordeaux University Hospital, Bordeaux, France.
¹³ Neurology Department, Rouen University Hospital, Rouen, France.
¹⁴ Stroke Unit, Strasbourg University Hospital, Strasbourg, France.
¹⁵ Neurology Department, CHU Nantes, Nantes, France.
¹⁶ APHP, Stroke Unit, Sorbonne University, ICM U1127, Brain Institute iCRIN, Pitié-Salpétrière Hospital, Paris, France.
¹⁷ Neurology Department, University Hospital of Nancy, Nancy, France.
¹⁸ Neurology Department, Rene Dubos Hospital, Pontoise, France.
¹⁹ Neurology Department, CH Metropole Savoie, Chambery, France.
²⁰ Neurology Department, CHR Orléans, Orléans, France.
²¹ Neurology Department, Foch Hospital, Suresnes, France.
²² Neurology Department, CHU Dijon, Dijon, France.
²³ Neurology Department, CHU Reims, Reims, France.
²⁴ Neurology Department, Geneva University Hospital, Geneva, Switzerland.
²⁵ Neurology Department, Stroke-Unit, CHU Saint-Etienne, Saint-Etienne, France.
²⁶ Netzwerk Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
²⁷ Stanford Stroke Center, Stanford University, Palo Alto, CA, USA.
²⁸ Université Paris Cité, Paris, France.
²⁹ Neurology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France.
³⁰ Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France.
³¹ Neurology Department, Lariboisière Hospital, APHP Nord, INSERM 1148, FHU Neurovasc, Université Paris Cité, Paris, France.
³² Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.

PMID: 39665302
DOI: 10.1177/17474930241309533

Multicenter Study

Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management

Candice Sabben et al. Int J Stroke. 2025 Mar.

. 2025 Mar;20(3):347-356.

doi: 10.1177/17474930241309533. Epub 2025 Jan 3.

Authors

Collaborators

ACAPULCO collaborators:
Frédérique Charbonneau, Francois Delvoye, Michael Obadia, Julien Savatovsky, Mikael Mazighi, Pierre Seners, Davide Strambo, Patrik Michel, Guillaume Saliou, Elodie Ong, Yves Berthezene, Mirjam R Heldner, Pasquale Mordasini, Kateryna Antonenko, Sara Pilgram-Pastor, Martin Zbinden, Hilde Henon, Nicolas Bricout, Adrien Ter Schiphorst, Caroline Arquizan, Vincent Costalat, Loïc Legris, Olivier Detante, Thomas Agasse-Lafont, Clément Tracol, François Eugene, Denis Sablot, Guillaume Turc, Wagih Ben Hassen, Nour Nehme, Fernando Pico, Igor Sibon, Sylvain Ledure, Aude Triquenot-Bagan, Emmanuel Gerardin, Valérie Wolff, Mathieu Krug, Raoul Pop, Stéphane Kremer, Cécile Preterre, Hubert Desal, Andreea Aignatoaie, Canan Ozsancak, Christophe Magni, Charlotte Rosso, Mahmoud Elhorany, Frédéric Clarençon, Sébastien Richard, Benjamin Gory, Gioia Mione, Roxana Poll, Philippe Niclot, Lynda Benammar, Jérémie Papassin, Solène Moulin, Solène Soize, David Weisenburger Lile, Bertrand Lapergue, Yannick Béjot, Pierre-Olivier Comby, Emmanuel Carrera, Pierre Garnier, Claire Boutet, Gregory W Albers

Affiliations

¹ Neurology Department, Rothschild Foundation Hospital, Paris, France.
² Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
³ Stroke Center, Neurology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
⁴ Stroke Department, Hospices Civils de Lyon, Lyon, France.
⁵ Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
⁶ Neurology Department, Stroke Center, University of Lille, Inserm U1171, CHU Lille, LilNCog-Lille Neuroscience & Cognition, Lille, France.
⁷ Neurology Department, CHRU Gui de Chauliac, Montpellier, France.
⁸ Neurology Department, Stroke Unit, Grenoble Alpes University Hospital, University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France.
⁹ Neurology Department, CHU Rennes, Rennes, France.
¹⁰ Neurology Department, CH Perpignan, Perpignan, France.
¹¹ Neurology Department, André Mignot Hospital, Versailles, France.
¹² Stroke Unit, Bordeaux University Hospital, Bordeaux, France.
¹³ Neurology Department, Rouen University Hospital, Rouen, France.
¹⁴ Stroke Unit, Strasbourg University Hospital, Strasbourg, France.
¹⁵ Neurology Department, CHU Nantes, Nantes, France.
¹⁶ APHP, Stroke Unit, Sorbonne University, ICM U1127, Brain Institute iCRIN, Pitié-Salpétrière Hospital, Paris, France.
¹⁷ Neurology Department, University Hospital of Nancy, Nancy, France.
¹⁸ Neurology Department, Rene Dubos Hospital, Pontoise, France.
¹⁹ Neurology Department, CH Metropole Savoie, Chambery, France.
²⁰ Neurology Department, CHR Orléans, Orléans, France.
²¹ Neurology Department, Foch Hospital, Suresnes, France.
²² Neurology Department, CHU Dijon, Dijon, France.
²³ Neurology Department, CHU Reims, Reims, France.
²⁴ Neurology Department, Geneva University Hospital, Geneva, Switzerland.
²⁵ Neurology Department, Stroke-Unit, CHU Saint-Etienne, Saint-Etienne, France.
²⁶ Netzwerk Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
²⁷ Stanford Stroke Center, Stanford University, Palo Alto, CA, USA.
²⁸ Université Paris Cité, Paris, France.
²⁹ Neurology Department, GHU Paris Psychiatrie and Neurosciences, Paris, France.
³⁰ Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France.
³¹ Neurology Department, Lariboisière Hospital, APHP Nord, INSERM 1148, FHU Neurovasc, Université Paris Cité, Paris, France.
³² Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.

PMID: 39665302
DOI: 10.1177/17474930241309533

Abstract

Background and aims: The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.

Methods: We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6 h from symptoms onset in 26 stroke centers in France, Switzerland, and the United States, treated with the best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ⩾2 at 3 months or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable and then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.

Results: Overall, 585 patients were included. The median age was 74 years (interquartile range (IQR) = 63-83), median National Institutes of Health Stroke Scale (NIHSS) was 6 (3-10), 80% received intravenous thrombolysis (IVT), and 22% and 78% had P1 and P2 occlusions, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted odds ratio (OR) = 1.12 per 5-year increase [95% confidence interval (CI) = 1.05-1.20]; p = 0.001), NIHSS score (aOR = 1.12 per each point increase [1.08-1.18]; p < 0.001), infarct volume (aOR = 1.16 per 5 mL increase [1.07-1.25]; p < 0.001), and the lack of IVT use (aOR = 1.79 [1.10-2.94], p = 0.020) were independently associated with poor outcome. Regarding 24-h follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR = 0.37 [95% CI = 0.21-0.65], p < 0.001) and parenchymal hematoma occurrence (aOR = 2.37 [95% CI = 1.01-5.56], p = 0.048) were independently associated with poor 3-month outcome.

Conclusions: Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.

Keywords: Cerebral infarction; acute stroke treatment; medical treatment; posterior cerebral artery; prognosis; thrombolysis.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr M.R.H. reports grants from Swiss National Science Foundation, SITEM Research Support Funds, and Swiss Heart Foundation, not directly related to this manuscript. Professor C.R. receives fees from OTR3 for her participation in a DSMB. Y.B. reports personal fees from BMS, Pfizer, Medtronic, Amgen, Servier, NovoNordisk, Novartis, and Laboratoire XO, outside the submitted work. Dr G.W.A. reports stock holdings in iSchemaView; compensation from Biogen, iSchemaView, and Genentech for consultant services. Dr G.T. reports lecture fees from Guerbert France and consultant services for AI-Stroke. Professor M.M. reports consulting fees from Acticor Biotech, and Boerhinger. Dr P.S. receives speaker fees from Acticor Biotech. Other authors have nothing to disclose.

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Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management

Collaborators

Affiliations

Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical