Abstract
PurposeThrombectomy has been the gold standard therapy for anterior circulation occlusion; however, studies regarding thrombectomy in posterior circulation are lacking. In this study, we compared the efficiency of thrombectomy for acute large vessel occlusion between the posterior and anterior circulation at a single institution.MethodsWe retrospectively analyzed consecutive patients who underwent thrombectomy for acute large vessel occlusion at our institution between August 2014 and April 2021. Differences in the clinical background, time course, and treatment technique and outcomes were evaluated between anterior and posterior circulation occlusions.ResultsOverall, 353 patients (225 men and 128 women) were included: 314 patients had anterior circulation occlusion and 39 patients had posterior circulation occlusion. Between the patients with anterior and posterior circulation occlusions, the National Institutes of Health Stroke Scale (NIHSS) score (16 [12–21] vs. 29 [19–34], respectively, p < 0.001), door-to-puncture time (65 [45–99] vs. 99 [51–121] min, respectively, p = 0.018), and mortality (22 [7%] vs. 8 [20.5%] patients, respectively, p = 0.010) were significantly different; however, favorable outcome was not significantly different.ConclusionHigher NIHSS score, delayed treatment, and higher mortality were observed in posterior circulation occlusion than in anterior circulation occlusion; successful reperfusion and favorable outcomes were similar between them. Similar favorable outcomes and reperfusion ratio to the anterior circulation might be achieved also in the posterior circulation; however, delayed treatment and the optimal first-pass strategy might need further improvement.
Highlights
The effectiveness of thrombectomy using conventional devices for acute large vessel occlusion was lacking evidence for a long time [1,2,3]
The indications for thrombectomy included (1) acute large vessel occlusion within 6 h from onset; (2) National Institutes of Health Stroke Scale (NIHSS) score [32] ≥ 6; (3) DWI-ASPECTS [33] ≥ 6 in ICA and M1 occlusion [9]; (4) mismatch area ≥ 1 in DWI-ASPECTS between hyperintensity on diffusion-weighted imaging (DWI) and estimated perfusion area of the occluded vessel on magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in M2 occlusion; (5) no pc-ASPECTS [34] based on DWI limit; and (6) no age limit
About the background characteristics, such as age, sex, comorbidity, history of smoking, inter-hospital transfer, drip-and-ship, in-hospital onset, NIHSS score, left-sided lesion, location of lesion, DWI-ASPECTS, pc-ASPECTS based on DWI, disease subtype, and tandem lesions, were evaluated
Summary
The effectiveness of thrombectomy using conventional devices for acute large vessel occlusion was lacking evidence for a long time [1,2,3]. It is reported to result in a higher National Institutes of Health Stroke Scale (NIHSS) score, higher mortality, and lower rate of favorable outcomes in comparison with anterior circulation occlusion [21,22,23,24,25]. We evaluated and compared the characteristics of posterior circulation occlusion with those of anterior circulation occlusion at a single institution
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