PREMISE: Posterior Circulation Results Comparing Embolectomy to Medical Intervention in Stroke Emergencies

Area of Science:

• Neurology
• Vascular Neurology
• Interventional Neurology

Background:

• Intravenous (IV) tissue plasminogen activator (rt-PA) is standard for acute stroke within its treatment window.
• Limited guidelines exist for posterior circulation stroke, specifically basilar artery occlusion (BAO), outside the rt-PA window.
• Recent advances show embolectomy efficacy in anterior circulation strokes up to 24 hours.

Purpose of the Study:

• To compare outcomes between maximal medical treatment and thrombectomy for basilar artery occlusion (BAO).
• To evaluate treatment strategies for posterior circulation stroke outside the standard IV rt-PA window.

Main Methods:

• Retrospective analysis of acute stroke patients (2004-2016), excluding those receiving IV rt-PA.
• Included patients with posterior circulation ischemia and hyperdense artery sign or confirmed BAO on vessel imaging.
• Compared outcomes (Modified Rankin Scale at 90 days, discharge location) between endovascular therapy and medical treatment alone.

Main Results:

• 18 patients included: 3 underwent embolectomy, 15 received medical therapy only.
• No significant demographic differences between groups.
• No statistical difference in functional outcome (mRS 0-3 at 90 days) or discharge location between medical and endovascular groups.

Conclusions:

• Observed a shift from medical management to including embolectomy for posterior circulation BAOs.
• Small sample size limits definitive conclusions on optimal treatment strategies.
• Highlights ongoing challenges and lack of clear efficacy data for posterior circulation stroke treatment outside the rt-PA window.