First‐Line Stent Retriever Versus Contact Aspiration or Combined Technique for Endovascular Therapy of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

Author:

Nguyen Thanh N.12ORCID,Abdalkader Mohamad2ORCID,Qureshi Muhammad M.23ORCID,Michel Patrik4ORCID,Strambo Davide4ORCID,Strbian Daniel5ORCID,Herweh Christian6ORCID,Möhlenbruch Markus A.6ORCID,Räty Silja5ORCID,Olive‐Gadea Marta7ORCID,Ribo Marc7ORCID,Psychogios Marios8ORCID,Fischer Urs910ORCID,Nguyen Anh11ORCID,Kuramatsu Joji B.12ORCID,Haupenthal David12ORCID,Köhrmann Martin1314ORCID,Deuschl Cornelius15ORCID,Escolà Jordi Kühne14ORCID,Demeestere Jelle1617ORCID,Vandewalle Lieselotte1617ORCID,Yaghi Shadi18ORCID,Shu Liqi18ORCID,Puetz Volker1920ORCID,Kaiser Daniel P.O.2021ORCID,Kaesmacher Johannes22ORCID,Mujanovic Adnan22ORCID,Marterstock Dominique Cornelius23ORCID,Engelhorn Tobias23ORCID,Klein Piers2ORCID,Haussen Diogo C.24ORCID,Mohammaden Mahmoud H.24ORCID,Fragata Isabel25ORCID,Cunha Bruno25,Abdelhamid Hend24ORCID,Romoli Michele26ORCID,Diana Francesco27ORCID,Virtanen Pekka2829ORCID,Lappalainen Kimmo2829ORCID,Jesser Jessica6ORCID,Clark Judith1,Matsoukas Stavros30ORCID,Fifi Johanna T.30ORCID,Sheth Sunil A.31ORCID,Salazar‐Marioni Sergio31ORCID,Marto João Pedro32ORCID,Ramos João Nuno33,Miszczuk Milena34ORCID,Riegler Christoph35ORCID,Poli Sven3637ORCID,Poli Khouloud36ORCID,Jadhav Ashutosh P.38ORCID,Desai Shashvat M.38ORCID,Maus Volker3940ORCID,Kaeder Maximilian39ORCID,Masoud Hesham E.41ORCID,Suryadareva Neil42,Mokin Maxim43ORCID,Siegler James E.44ORCID,Linfante Italo45ORCID,Dabus Guilherme45ORCID,Asdaghi Negar46ORCID,Saini Vasu46ORCID,Nolte Christian H.35ORCID,Siebert Eberhard34ORCID,Meinel Thomas R.47ORCID,Weyland Charlotte S.48ORCID,Hanning Uta49ORCID,Meyer Lukas49ORCID,Nogueira Raul G.42ORCID,Ringleb Peter A.50,Nagel Simon5051ORCID

Affiliation:

1. Neurology Boston Medical Center Boston MA

2. Radiology Boston Medical Center Boston MA

3. Radiation Oncology Boston Medical Center Boston MA

4. Neurology Service Lausanne University Hospital University of Lausanne Switzerland

5. Neurology Helsinki University Hospital Finland

6. Neuroradiology Heidelberg University Hospital Germany

7. Neurology Hospital Universitario Vall d'Hebron Barcelona Spain

8. Basel University Hospital University of Basel Switzerland

9. Neurology University Hospital Basel Basel Switzerland

10. Neurology University Hospital Bern Bern Switzerland

11. Radiology University of Basel Switzerland

12. Neurology University of Erlangen‐Nuremberg Erlangen Germany

13. Neurology University Hospital Essen Essen Germany

14. Department of Neurology University Hospital Essen Essen Germany

15. Institute of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany

16. Department of Neurosciences Experimental Neurology KU Leuven Leuven Belgium

17. Department of Neurology University Hospitals Leuven Leuven Belgium

18. Neurology Rhode Island Hospital RI

19. Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Germany

20. Dresden Neurovascular Center University Hospital Carl Gustav Carus, Technische Universität Dresden Dresden Germany

21. Neuroradiology, University Hospital Carl Gustav Carus Technische Universität Dresden Germany

22. Institute of Diagnostic and Interventional Neuroradiology University Hospital Bern Inselspital University of Bern Bern Switzerland

23. Neuroradiology University of Erlangen‐Nuremberg Erlangen Germany

24. Neurology Grady Memorial Hospital Atlanta GA

25. Neuroradiology Centro Hospitalar Universitario de Lisboa Central Portugal

26. Neurology and Stroke Unit Department of Neuroscience Bufalini Hospital Cesena Italy

27. Interventional Neuroradiology Vall d'Hebron University Hospital Barcelona Spain

28. Radiology Helsinki University Hospital Finland

29. Radiology Helsinki University Hospital University of Helsinki Helsinki Finland

30. Neurosurgery Mount Sinai Health System NY

31. Neurology McGovern Medical School at UTHealth TX

32. Neurology Hospital de Egas Moniz Centro Hospitalar Lisboa Ocidental Portugal

33. Neuroradiology Hospital de Egas Moniz Centro Hospitalar Lisboa Ocidental Portugal

34. Neuroradiology Charité – Universitätsmedizin Berlin Freie Universität Berlin and Humboldt‐Universität Germany

35. Neurology Experimental Neurology and Center for Stroke Research Berlin (CSB) and Berlin Institute of Health (BIH) Charité – Universitätsmedizin Berlin Freie Universität Berlin and Humboldt‐Universität zu Berlin Germany

36. Neurology & Stroke University of Tübingen Germany

37. Hertie‐Institute for Clinical Brain Research University of Tübingen Germany

38. Neurosurgery Barrow Neurological Institute AZ

39. Radiology Neuroradiology and Nuclear Medicine University Hospital Knappschaftskrankenhaus Bochum Germany

40. Klinikum Aschaffenburg Aschaffenburg Germany

41. Neurology New York Upstate Medical University NY

42. Neurology University of Pittsburgh Medical Center PA

43. Neurosurgery University of South Florida FL

44. Cooper Neurological Institute NJ

45. Miami Neuroscience Institute FL

46. Neurology University of Miami Miller School of Medicine FL

47. Neurology Bern University Hospital University of Bern Switzerland

48. Neuroradiology University Hospital RWTH Aachen Germany

49. Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Germany

50. Neurology Heidelberg University Hospital Germany

51. Neurology Heidelberg University Hospital Heidelberg Germany

Abstract

Background The optimal reperfusion technique in patients with isolated posterior cerebral artery (PCA) occlusion is uncertain. We compared clinical and technical outcomes with first‐line stent retriever (SR), contact aspiration (CA), or combined techniques in patients with isolated PCA occlusion. Methods This international case–control study was conducted at 30 sites in Europe and North America and included consecutive patients with isolated PCA occlusion presenting within 24 hours of time last seen well from January 2015 to August 2022. The primary outcome was the first‐pass effect (FPE), defined as expanded Treatment in Cerebral Infarction (TICI) 2c/3 on the first pass. Patients treated with SR, CA, or combined technique were compared with multivariable logistic regression. Results There were 326 patients who met inclusion criteria, 56.1% male, median age 75 (interquartile range 65–82) years, and median National Institutes of Health Stroke Scale score 8 (5–12). Occlusion segments were PCA‐P1 (53.1%), P2 (40.5%), and other (6.4%). Intravenous thrombolysis was administered in 39.6%. First‐line technique was SR, CA, and combined technique in 43 (13.2%), 106 (32.5%), and 177 (54.3%) patients, respectively; FPE was achieved in 62.8%, 42.5%, and 39.6%, respectively. FPE was lower in patients treated with first‐line CA or combined technique compared with SR (CA versus SR: adjusted odds ratio 0.45 [0.19–1.06]; P =0.07; combined versus SR: adjusted odds ratio 0.35 [0.016–0.80]; P =0.01). There were lower odds of functional independence (modified Rankin scale score 0–2) in the first‐line CA versus SR alone group (adjusted odds ratio 0.52 [0.28–0.95]; P =0.04). FPE was associated with higher rates of favorable outcomes (modified Rankin scale score 0–2: 58% versus 43.4%; P =0.01; modified Rankin scale score 0–1: 36.6% versus 25.8%; P =0.05). Overall, symptomatic intracranial hemorrhage was present in 5.6% (18/326) and mortality in 10.9% (35/326) without difference between first‐line technique. Conclusion In patients with isolated PCA occlusion, SR was associated with a higher rate of FPE compared with CA or combined techniques with no difference in final successful reperfusion. Functional independence at 90 days was more likely with first‐line SR compared with CA. FPE was associated with better 90‐day clinical outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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