E-084 proximal versus distal occlusions in the posterior circulation: acute stroke etiology in endovascular therapy

作者：May Nour, Satoshi Tateshima, Gary Duckwiler, Reza Jahan, Nestor R. Gonzalez, Viktor Szeder, Luu Dang Ai, Jeffrey L. Saver, David S. Liebeskind · 年份：2015 · DOI：10.1136/neurintsurg-2015-011917.159 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases

Background Acute posterior circulation stroke carries substantial morbidity and mortality. Development of second-generation clot retrieval devices has facilitated an improvement in recanalization rates, yet response to revascularization based on etiology has not been discerned. While overwhelmingly positive results have validated endovascular thrombectomy in multiple, randomized clinical trials (MR-CLEAN, EXTEND-IA, ESCAPE, SWIFT-PRIME) as a therapy responsible for significant improvement in patient clinical outcomes, these trials have only evaluated anterior circulation occlusions. In this study, we focused on the role of stroke etiology in endovascular therapy of posterior circulation strokes in the stentriever era. Methods Retrospective review of consecutive cases treated between March 2011 to August 2014, from a total of 216 acute endovascular intervention cases. Cases were evaluated for clinical and radiographic presentation, vascular risk factors, angiographic diagnostic findings, treatment and outcomes. Results Amongst 216 consecutive acute stroke endovascular therapy cases, 20 patients (9.3%) presented with posterior circulation stroke, ages ranging from 39 to 93 years (mean of 66.5), 75% of whom were men. NIHSS ranged from 1, fluctuating to loss of consciousness, to an initial presenting NIHSS of 35. Seventeen cases were treated and analyzed based on clot location defining proximal occlusion as distal vertebral arteries, vertebrobasilar junction and proximal-to-...