Endovascular therapy versus no endovascular therapy in patients receiving best medical management for acute isolated occlusion of the posterior cerebral artery: A systematic review and <scp>meta‐analysis</scp>
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- Anne Berberich
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
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- Stephanos Finitsis
- Department of Radiology Aristotle University of Thessaloniki Thessaloniki Greece
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- Davide Strambo
- Department of Neurology Lausanne University Hospital and University of Lasaunne Lausanne Switzerland
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- Patrik Michel
- Department of Neurology Lausanne University Hospital and University of Lasaunne Lausanne Switzerland
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- Christian Herweh
- Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
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- Lukas Meyer
- Department of Radiology Hamburg University Hospital Hamburg Germany
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- Uta Hanning
- Department of Radiology Hamburg University Hospital Hamburg Germany
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- Daniel Strbian
- Department of Neurology Helsinki University Hospital Helsinki Finland
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- Mohamad Abdalkader
- Department of Radiology Boston Medical Center Boston Massachusetts USA
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- Raul G. Nogueira
- UPMC Stroke Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
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- Volker Puetz
- Department of Neurology Dresden University Hospital Dresden Germany
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- Daniel P. O. Kaiser
- Dresden Neurovascular Center Dresden University Hospital Dresden Germany
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- Marta Olive‐Gadea
- Stroke Unit, Department of Neurology Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona Barcelona Spain
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- Marc Ribo
- Stroke Unit, Department of Neurology Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona Barcelona Spain
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- Isabel Fragata
- Department of Neuroradiology Centro Hospitalar Universitário de Lisboa Central Lisbon Portugal
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- João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
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- Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience Bufalini Hospital Cesena Italy
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- Peter A. Ringleb
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
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- Thanh N. Nguyen
- Department of Neurology Radiology Boston Medical Center Boston Massachusetts USA
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- Simon Nagel
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
抄録
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background and purpose</jats:title><jats:p>Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study‐level meta‐analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0–2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twelve studies with a total of 679 patients were included in the meta‐analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83–70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35–55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30–20.93) and 12.3% (95% CI 8.64–17.33). sICH occurred in 4.2% (95% CI 2.47–7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75–5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.</jats:p></jats:sec>
収録刊行物
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- European Journal of Neurology
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European Journal of Neurology 29 (9), 2664-2673, 2022-06-17
Wiley