Introduction: In acute ischemic stroke (AIS), posterior circulation large vessel occlusions (LVO) have been associated with poorer outcomes compared to anterior circulation LVO. Using a strategy for determining candidacy relying on CT perfusion rather than time parameters, the outcomes of anterior vs. posterior circulation thrombectomy for LVO were compared at a high volume center employing a direct aspiration first pass technique (ADAPT).
Methods: We retrospectively studied a database of AIS cases that underwent ADAPT thrombectomy for large vessel occlusions. Cases were grouped by anatomical location of thrombectomy (posterior vs. anterior circulation), and analysis was performed on both entire sample size and on matched subsets within each group.
Results: A total of 436 AIS patients (50.2% women, mean age 67.3 years) underwent ADAPT thrombectomy for LVO during the study period of which 13% of had posterior circulation thrombectomy. Patients with posterior circulation thrombectomy did not show a significant difference in pre-procedural variables including age, baseline NIHSS and onset to groin time compared to anterior circulation (p>0.05). There were also no differences in procedural variables between the two groups. Patients in the posterior group were found to have a similar likelihood of good outcome (mRS 0—2) at 90 days compared to the anterior group (42.9% vs. 43.2% respectively) and a small but not significant increase in mortality at 90 days. Multivariate logistic regression analysis shows that the anatomical location (anterior vs. posterior) is not an independent predictor of good outcome or mortality after thrombectomy. Prominent predictors of outcome/mortality include age, female gender, procedure time, and baseline NIHSS.
Conclusion: Our findings suggest that posterior circulation thrombectomy for LVO has a similar outcome and a similar rate of post-procedural complications compared to anterior circulation thrombectomy indicating comparable safety and efficacy profiles.