Endovascular recanalization for acute posterior cerebral artery occlusion: a pre-specified secondary analysis of the ATTENTION, BAOCHE, and PLATO studies - Report - MDSpire
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Endovascular recanalization for acute posterior cerebral artery occlusion: a pre-specified secondary analysis of the ATTENTION, BAOCHE, and PLATO studies
Endovascular Thrombectomy for Acute Occlusion of the Posterior Cerebral Artery
Background
Acute ischemic stroke due to posterior cerebral artery occlusion can lead to significant disability, yet evidence supporting EVT for this condition is limited. The established efficacy of EVT in anterior circulation strokes does not directly translate to posterior circulation, particularly for PCA occlusions.
Data Highlights
Study
Adjusted Risk Ratio (aRR)
Confidence Interval (CI)
ATTENTION
2.06
1.46–2.91
BAOCHE
1.81
1.26–2.60
PLATO (functional recovery)
1.13
0.85–1.50
PLATO (complete vision recovery)
N/A
70% vs. 43%, p = 0.002
PLATO (mortality signal)
RR 2.15
1.32–3.50
Key Findings
ATTENTION and BAOCHE trials provide indirect evidence supporting EVT for posterior circulation occlusions.
PLATO trial offers direct evidence for PCA occlusion, suggesting potential benefits in functional recovery.
Complete vision recovery was significantly higher in the EVT group compared to medical management.
There is a higher mortality signal associated with EVT in PCA occlusion cases.
The evidence assessment scores high for principle feasibility in RCTs and target-specificity in PLATO.
A critical gap exists in dedicated RCT evidence for PCA thrombectomy.
Clinical Implications
Further dedicated RCTs are needed to establish definitive guidelines for PCA thrombectomy.
Conclusion
Further research is needed to validate these findings.
