IV tPA or Mechanical Thrombectomy: Is One Better for Acute Posterior Cerebral Artery Occlusions?
Elizabeth M. Aradine, DO
Strambo D, Bartonlini B, Beaud V, Marto JP, Sirimarco G, Dunet V, et al. Thrombectomy and Thrombolysis of Isolated Posterior Cerebral Artery Occlusion: Cognitive, Visual, and Disability Outcomes. Stroke. 2019.
The benefit of mechanical thrombectomy (MT) compared to IV thrombolysis (tPA) for the treatment of an acute posterior cerebral artery (PCA) occlusion is uncertain. Patients with a PCA occlusion can have a low NIH stroke scale (NIHSS), a population that is underrepresented in mechanical thrombectomy trials. The PCA territory provides vascularization to the thalamus, the hub of cerebral connections not only for motor and sensory pathways, but also for cognition. Impaired cognition is not represented on the NIHSS, which further underestimates the deficits of a PCA occlusion. The authors of “Thrombectomy and Thrombolysis of Isolated Posterior Cerebral Artery Occlusion” sought to understand the impact of revascularization with MT, tPA, or conservative treatment and assessed the outcomes of visual field deficit, cognitive impairment, and disability.
This retrospective observational study included all acute stroke patients with radiographic evidence of a P1, P2, or fetal PCA occlusion. Analysis was separated into three treatment groups: conservative therapy (no tPA), tPA, and MT. The following outcomes were assessed: visual field normalization on confrontation, 90-day modified Rankin Scale (mRS), and cognitive function. Cognitive function was evaluated by a neuropsychologist in the subacute hospital, and a favorable outcome was defined as less than or equal to 2 impaired cognitive domains.