Article Commentary: “Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice”
Tolga D. Dittrich, MD
Pirson FAV, Boodt N, Brouwer J, Bruggeman AAE, den Hartog SJ, Goldhoorn R-JB, Langezaal LCM, Staals J, van Zwam WH, van der Leij C, et al., and on behalf of the MR CLEAN Registry Investigators. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry. Stroke. 2021.
In contrast to anterior circulation stroke, the evidence for endovascular treatment (EVT) of posterior circulation stroke remains low. In practice, this means that clinicians still face uncertainties regarding the benefit of EVT, with the decision often based on the individual assessment of the treating physician.
In their observational study, Pirson and colleagues compared outcomes of patients who received EVT outside of the BASICS trial at study centers with those from non-study centers. Of 264 patients included, the majority (77%) had basilar artery involvement, with 51% receiving intravenous thrombolysis. A modified Rankin Scale score of 0 to 3 was achieved by 46% (115/252), and 43% (109/252) of patients died. Successful reperfusion was established in 75% (178/238), and symptomatic intracranial hemorrhage was rare, totaling 3% (9/264). Functional outcome was comparable between BASICS study centers and non-study centers (cOR: 0.77 [95%CI, 0.5-1.2]).