Posterior circulation stroke thrombectomy – a mortality-reducing procedure
The year 2022 brought two positive trials for posterior circulation stroke, both performed in China. The experience with previous basilar trials has made it possible to limit cross-over rates, focus on an adequate population, and choose the right primary outcome measure. These combined factors were responsible for the positive results of these basilar occlusion trials, which showed not just improvement in disability but also mortality. The scope of this short review is not to go through the trials but to provide the practitioner with the relevant details for the minimal work-up needed to treat a basilar thrombosis in the clinical practice rapidly.
Key points of the literature evidence:
CLINICAL RELEVANCE AND EXTERNAL VALIDITY OF THE TWO TRIALS:
Available data supports thrombectomy for basilar occlusions. MRI imaging seems not to be of significant use for the clinical selection of these patients in early or late time windows. All local protocols should focus on obtaining rapid, simple – imaging selection for patients with basilar artery occlusion.
1. Jovin TG, Li C, Wu L, Wu C, Chen J, Jiang C, et al. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. New England Journal of Medicine. 2022 Oct 13;387(15):1373–84.
2. Tao C, Nogueira RG, Zhu Y, Sun J, Han H, Yuan G, et al. Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. New England Journal of Medicine 2022 Oct 13 387(15):1361–72.
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