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Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke-Insights from the STAR Collaboration
Ali M Alawieh1,2, Maya Eid1, Mohammad Anadani3
1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
Neurosurgery
|May 21, 2020
Summary
Mechanical thrombectomy (MT) for posterior circulation stroke shows ADAPT technique yields better functional independence than stent retrievers or combined approaches. This large study highlights technique choice as crucial for stroke outcomes.
Area of Science:
- Neuroscience
- Interventional Neurology
- Vascular Neurology
Background:
- Prior mechanical thrombectomy (MT) research primarily focused on anterior circulation strokes.
- Limited large-scale data exists on predictors of outcome for posterior circulation stroke MT.
- Understanding procedural and clinical factors is crucial for optimizing posterior circulation stroke treatment.
Purpose of the Study:
- To identify technical and clinical predictors of functional independence in posterior circulation stroke patients undergoing MT.
- To compare the effectiveness of different frontline thrombectomy techniques (aspiration, stent retriever, combined approach) in posterior circulation stroke.
Main Methods:
- Retrospective analysis of 345 posterior circulation stroke patients from a multicenter international study (06/2014-12/2018).
- Mechanical thrombectomy (MT) performed using contact aspiration (ADAPT), stent retriever, or combined approaches.
- Functional outcomes assessed by modified Rankin Scale (mRS) at 90 days (good: 0-2, poor: 3-6).
Main Results:
- Posterior circulation stroke patients experienced delayed treatment (500 vs 340 min) and higher NIHSS scores compared to anterior circulation.
- Lower rates of good functional outcomes (31% vs 43%) were observed in posterior circulation stroke patients.
- In posterior circulation MT, diabetes, higher admission NIHSS, and use of stent retriever or combined approach were associated with poorer outcomes compared to ADAPT.
Conclusions:
- The Aspiration, Diversion, Perfusion (ADAPT) technique is associated with higher rates of functional independence in posterior circulation stroke.
- Stent retriever or combined approaches showed lower odds of good outcomes compared to ADAPT in this real-world study.
- Procedural choice, specifically ADAPT, appears to be a significant factor in improving functional independence after posterior circulation thrombectomy.
