Introduction: Patients presenting with acute ischemic stroke due to a large vessel occlusion of the anterior circulation (usually M1), are now offered thrombectomy after 6 major trials demonstrated superior results over IV tPA alone. However, there are few trials evaluating the benefit of clot retrieval in posterior circulation strokes. Our goal was to evaluate the benefit of thrombectomy for posterior circulation strokes.
Methods: We conducted a comprehensive record review of patients who underwent acute endovascular intervention for posterior circulation ischemia at a community based, university affiliated comprehensive stroke center during a 5-year period (2010-2015). The initial NIHSS, discharge NIHSS and discharge mRS were abstracted. We compared discharge mRS to composite 90 DAYS mRS of six recent multi-centered prospective randomized control trials (MPRCT) for acute endovascular treatment of acute ischemic stroke involving large vessel occlusions (SWIFT PRIME, ESCAPE, MR CLEAN, EXTEND-IA, REVASCAT, THERAPY).
Results: There were 2,980 patients who presented with acute ischemic stroke during the pre-specified time period. Of those 310 were posterior circulation strokes; of which, 34 underwent endovascular treatment. These were compared with 1,386 patients with proximal anterior circulation strokes included in the recent MPRCTs. The mean age was 62 (SD=12). Mean initial NIHSS was 12 (SD=11). Mean change in NIHSS was 4 (SD =6). Mean discharge NIHSS was 9 (SD=11). Mean discharge mRS was 2.6 (SD=2.1).
Conclusion: The benefits of thrombectomy for posterior circulation strokes compare well with those recently achieved by the trials evaluating the treatment for anterior circulation strokes. A prospective randomized trial comparing this option with the standard of care should be attempted to better elucidate the results.