Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

Thanh N. Nguyen; Muhammad M. Qureshi; Davide Strambo; Daniel Strbian; Silja Raety; Christian Herweh; Mohamad Abdalkader; Marta Olive-Gadea; Marc Ribo; Marios Psychogios; Urs Fischer; Anh Nguyen; Joji B. Kuramatsu; David Haupenthal; Martin Koehrmann; Cornelius Deuschl; Jordi Kuehne Escola; Shadi Yaghi; Liqi Shu; Volker Puetz; Daniel P. O. Kaiser; Johannes Kaesmacher; Adnan Mujanovic; Dominique Cornelius Marterstock; Tobias Engelhorn; Piers Klein; Diogo C. Haussen; Mahmoud H. Mohammaden; Hend Abdelhamid; Lorena Souza Viana; Bruno Cunha; Isabel Fragata; Michele Romoli; Francesco Diana; Pekka Virtanen; Kimmo Lappalainen; Judith Clark; Stavros Matsoukas; Johanna T. Fifi; Sunil A. Sheth; Sergio Salazar-Marioni; Joao Pedro Marto; Joao Nuno Ramos; Milena Miszczuk; Christoph Riegler; Ashutosh P. Jadhav; Shashvat M. Desai; Volker Maus; Maximilian Kaeder; Adnan H. Siddiqui; Andre Monteiro; Hesham E. Masoud; Neil Suryadevara; Maxim Mokin; Shail Thanki; James E. Siegler; Jane Khalife; Italo Linfante; Guilherme Dabus; Negar Asdaghi; Vasu Saini; Christian H. Nolte; Eberhard Siebert; Thomas R. Meinel; Stefanos Finitsis; Markus A. Moehlenbruch; Peter A. Ringleb; Anne Berberich; Raul G. Nogueira; Uta Hanning; Lukas Meyer; Patrik Michel; Simon Nagel

doi:10.1161/STROKEAHA.123.042674

Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

Thanh N. Nguyen, Muhammad M. Qureshi, Davide Strambo, Daniel Strbian, Silja Raety, Christian Herweh, Mohamad Abdalkader, Marta Olive-Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji B. Kuramatsu, David Haupenthal, Martin Koehrmann, Cornelius Deuschl, Jordi Kuehne Escola, Shadi Yaghi, Liqi Shu, Volker PuetzDaniel P. O. Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstock, Tobias Engelhorn, Piers Klein, Diogo C. Haussen, Mahmoud H. Mohammaden, Hend Abdelhamid, Lorena Souza Viana, Bruno Cunha, Isabel Fragata, Michele Romoli, Francesco Diana, Pekka Virtanen, Kimmo Lappalainen, Judith Clark, Stavros Matsoukas, Johanna T. Fifi, Sunil A. Sheth, Sergio Salazar-Marioni, Joao Pedro Marto, Joao Nuno Ramos, Milena Miszczuk, Christoph Riegler, Ashutosh P. Jadhav, Shashvat M. Desai, Volker Maus, Maximilian Kaeder, Adnan H. Siddiqui, Andre Monteiro, Hesham E. Masoud, Neil Suryadevara, Maxim Mokin, Shail Thanki, James E. Siegler, Jane Khalife, Italo Linfante, Guilherme Dabus, Negar Asdaghi, Vasu Saini, Christian H. Nolte, Eberhard Siebert, Thomas R. Meinel, Stefanos Finitsis, Markus A. Moehlenbruch, Peter A. Ringleb, Anne Berberich, Raul G. Nogueira, Uta Hanning, Lukas Meyer, Patrik Michel, Simon Nagel

Klinikum Rosenheim

Research output: Contribution to journal › Original Article › peer-review

58 Citations (Web of Science)

Abstract

Background:The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods:This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and & GE;2-point decrease in the National Institutes of Health Stroke Scale. Results:Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by & GE;2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions:In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

Original language	English
Pages (from-to)	1708-1717
Number of pages	10
Journal	STROKE
Volume	54
Issue number	7
DOIs	https://doi.org/10.1161/STROKEAHA.123.042674
Publication status	Published - Jul 2023

Keywords

Case-control studies
Cerebrovascular disorders
Logistic models
Posterior cerebral artery
Stroke
Thrombectomy
Thrombolytic therapy

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10.1161/STROKEAHA.123.042674

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Nguyen, T. N., Qureshi, M. M., Strambo, D., Strbian, D., Raety, S., Herweh, C., Abdalkader, M., Olive-Gadea, M., Ribo, M., Psychogios, M., Fischer, U., Nguyen, A., Kuramatsu, J. B., Haupenthal, D., Koehrmann, M., Deuschl, C., Escola, J. K., Yaghi, S., Shu, L., ... Nagel, S. (2023). Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. STROKE , 54(7), 1708-1717. https://doi.org/10.1161/STROKEAHA.123.042674

Nguyen, Thanh N. ; Qureshi, Muhammad M. ; Strambo, Davide et al. / Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke : The PLATO Study. In: STROKE 2023 ; Vol. 54, No. 7. pp. 1708-1717.

@article{13bedaf0256a4dd9b04f872fd1551953,

title = "Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study",

abstract = "Background:The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods:This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and & GE;2-point decrease in the National Institutes of Health Stroke Scale. Results:Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by & GE;2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions:In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.",

keywords = "Case-control studies, Cerebrovascular disorders, Logistic models, Posterior cerebral artery, Stroke, Thrombectomy, Thrombolytic therapy",

author = "Nguyen, {Thanh N.} and Qureshi, {Muhammad M.} and Davide Strambo and Daniel Strbian and Silja Raety and Christian Herweh and Mohamad Abdalkader and Marta Olive-Gadea and Marc Ribo and Marios Psychogios and Urs Fischer and Anh Nguyen and Kuramatsu, {Joji B.} and David Haupenthal and Martin Koehrmann and Cornelius Deuschl and Escola, {Jordi Kuehne} and Shadi Yaghi and Liqi Shu and Volker Puetz and Kaiser, {Daniel P. O.} and Johannes Kaesmacher and Adnan Mujanovic and Marterstock, {Dominique Cornelius} and Tobias Engelhorn and Piers Klein and Haussen, {Diogo C.} and Mohammaden, {Mahmoud H.} and Hend Abdelhamid and Viana, {Lorena Souza} and Bruno Cunha and Isabel Fragata and Michele Romoli and Francesco Diana and Pekka Virtanen and Kimmo Lappalainen and Judith Clark and Stavros Matsoukas and Fifi, {Johanna T.} and Sheth, {Sunil A.} and Sergio Salazar-Marioni and Marto, {Joao Pedro} and Ramos, {Joao Nuno} and Milena Miszczuk and Christoph Riegler and Jadhav, {Ashutosh P.} and Desai, {Shashvat M.} and Volker Maus and Maximilian Kaeder and Siddiqui, {Adnan H.} and Andre Monteiro and Masoud, {Hesham E.} and Neil Suryadevara and Maxim Mokin and Shail Thanki and Siegler, {James E.} and Jane Khalife and Italo Linfante and Guilherme Dabus and Negar Asdaghi and Vasu Saini and Nolte, {Christian H.} and Eberhard Siebert and Meinel, {Thomas R.} and Stefanos Finitsis and Moehlenbruch, {Markus A.} and Ringleb, {Peter A.} and Anne Berberich and Nogueira, {Raul G.} and Uta Hanning and Lukas Meyer and Patrik Michel and Simon Nagel",

note = "keine Aff. zu Klinikum Rosenheim",

year = "2023",

month = jul,

doi = "10.1161/STROKEAHA.123.042674",

language = "English",

volume = "54",

pages = "1708--1717",

journal = "STROKE ",

issn = "0039-2499",

publisher = "Lippincott Williams & Wilkins ",

number = "7",

}

Nguyen, TN, Qureshi, MM, Strambo, D, Strbian, D, Raety, S, Herweh, C, Abdalkader, M, Olive-Gadea, M, Ribo, M, Psychogios, M, Fischer, U, Nguyen, A, Kuramatsu, JB, Haupenthal, D, Koehrmann, M, Deuschl, C, Escola, JK, Yaghi, S, Shu, L, Puetz, V, Kaiser, DPO, Kaesmacher, J, Mujanovic, A, Marterstock, DC, Engelhorn, T, Klein, P, Haussen, DC, Mohammaden, MH, Abdelhamid, H, Viana, LS, Cunha, B, Fragata, I, Romoli, M, Diana, F, Virtanen, P, Lappalainen, K, Clark, J, Matsoukas, S, Fifi, JT, Sheth, SA, Salazar-Marioni, S, Marto, JP, Ramos, JN, Miszczuk, M, Riegler, C, Jadhav, AP, Desai, SM, Maus, V, Kaeder, M, Siddiqui, AH, Monteiro, A, Masoud, HE, Suryadevara, N, Mokin, M, Thanki, S, Siegler, JE, Khalife, J, Linfante, I, Dabus, G, Asdaghi, N, Saini, V, Nolte, CH, Siebert, E, Meinel, TR, Finitsis, S, Moehlenbruch, MA, Ringleb, PA, Berberich, A, Nogueira, RG, Hanning, U, Meyer, L, Michel, P & Nagel, S 2023, 'Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study', STROKE , vol. 54, no. 7, pp. 1708-1717. https://doi.org/10.1161/STROKEAHA.123.042674

Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. / Nguyen, Thanh N.; Qureshi, Muhammad M.; Strambo, Davide et al.
In: STROKE , Vol. 54, No. 7, 07.2023, p. 1708-1717.

Research output: Contribution to journal › Original Article › peer-review

TY - JOUR

T1 - Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke

T2 - The PLATO Study

AU - Nguyen, Thanh N.

AU - Qureshi, Muhammad M.

AU - Strambo, Davide

AU - Strbian, Daniel

AU - Raety, Silja

AU - Herweh, Christian

AU - Abdalkader, Mohamad

AU - Olive-Gadea, Marta

AU - Ribo, Marc

AU - Psychogios, Marios

AU - Fischer, Urs

AU - Nguyen, Anh

AU - Kuramatsu, Joji B.

AU - Haupenthal, David

AU - Koehrmann, Martin

AU - Deuschl, Cornelius

AU - Escola, Jordi Kuehne

AU - Yaghi, Shadi

AU - Shu, Liqi

AU - Puetz, Volker

AU - Kaiser, Daniel P. O.

AU - Kaesmacher, Johannes

AU - Mujanovic, Adnan

AU - Marterstock, Dominique Cornelius

AU - Engelhorn, Tobias

AU - Klein, Piers

AU - Haussen, Diogo C.

AU - Mohammaden, Mahmoud H.

AU - Abdelhamid, Hend

AU - Viana, Lorena Souza

AU - Cunha, Bruno

AU - Fragata, Isabel

AU - Romoli, Michele

AU - Diana, Francesco

AU - Virtanen, Pekka

AU - Lappalainen, Kimmo

AU - Clark, Judith

AU - Matsoukas, Stavros

AU - Fifi, Johanna T.

AU - Sheth, Sunil A.

AU - Salazar-Marioni, Sergio

AU - Marto, Joao Pedro

AU - Ramos, Joao Nuno

AU - Miszczuk, Milena

AU - Riegler, Christoph

AU - Jadhav, Ashutosh P.

AU - Desai, Shashvat M.

AU - Maus, Volker

AU - Kaeder, Maximilian

AU - Siddiqui, Adnan H.

AU - Monteiro, Andre

AU - Masoud, Hesham E.

AU - Suryadevara, Neil

AU - Mokin, Maxim

AU - Thanki, Shail

AU - Siegler, James E.

AU - Khalife, Jane

AU - Linfante, Italo

AU - Dabus, Guilherme

AU - Asdaghi, Negar

AU - Saini, Vasu

AU - Nolte, Christian H.

AU - Siebert, Eberhard

AU - Meinel, Thomas R.

AU - Finitsis, Stefanos

AU - Moehlenbruch, Markus A.

AU - Ringleb, Peter A.

AU - Berberich, Anne

AU - Nogueira, Raul G.

AU - Hanning, Uta

AU - Meyer, Lukas

AU - Michel, Patrik

AU - Nagel, Simon

N1 - keine Aff. zu Klinikum Rosenheim

PY - 2023/7

Y1 - 2023/7

N2 - Background:The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods:This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and & GE;2-point decrease in the National Institutes of Health Stroke Scale. Results:Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by & GE;2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions:In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

AB - Background:The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. Methods:This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and & GE;2-point decrease in the National Institutes of Health Stroke Scale. Results:Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by & GE;2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). Conclusions:In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.

KW - Case-control studies

KW - Cerebrovascular disorders

KW - Logistic models

KW - Posterior cerebral artery

KW - Stroke

KW - Thrombectomy

KW - Thrombolytic therapy

UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001017763100011&DestLinkType=FullRecord&DestApp=WOS_CPL

U2 - 10.1161/STROKEAHA.123.042674

DO - 10.1161/STROKEAHA.123.042674

M3 - Original Article

C2 - 37222709

SN - 0039-2499

VL - 54

SP - 1708

EP - 1717

JO - STROKE

JF - STROKE

IS - 7

ER -

Nguyen TN, Qureshi MM, Strambo D, Strbian D, Raety S, Herweh C et al. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. STROKE . 2023 Jul;54(7):1708-1717. doi: 10.1161/STROKEAHA.123.042674

Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

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