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Semin Neurol 2023; 43(03): 345-355
DOI: 10.1055/s-0043-1771210
Review Article

What Is the Evidence for Endovascular Thrombectomy in Posterior Circulation Stroke?

Authors

  • Silja Räty

    1   Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

  • Thanh N. Nguyen

    2   Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts

  • Simon Nagel

    3   Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen/Rhein, Germany
    4   Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

  • Volker Puetz

    5   Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
    6   Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

  • Fana Alemseged

    7   Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

  • Mohamad Abdalkader

    8   Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts

  • Wouter J. Schonewille

    9   Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands

  • Daniel Strbian

    1   Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Abstract

Posterior circulation infarcts comprise approximately 25% of ischemic strokes but are less often treated with recanalization therapy and have longer treatment delays compared with anterior circulation strokes. Among posterior circulation strokes, basilar artery occlusion is associated with the most severe deficits and the worst prognosis. Endovascular thrombectomy is a standard of care for patients with anterior circulation large vessel occlusion, but not until recently were the first randomized controlled trials on endovascular thrombectomy in basilar artery occlusion published. Two of the trials were neutral, whereas two others showed better functional outcome after thrombectomy up to 24 hours of symptom onset compared with best medical treatment, which in most cases had low rates of intravenous thrombolysis. According to observational data, thrombectomy seems to be safe also in isolated posterior cerebral artery occlusions and might be an option for selected patients, even if its outcome benefit is yet to be demonstrated.

Keywords

basilar artery occlusion - ischemic stroke - endovascular thrombectomy - posterior cerebral artery occlusion - review


Publication History

Article published online:
18 August 2023

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