Endovascular Treatment of Acute Ischemic Stroke Due to Isolated Proximal Posterior Artery Occlusion

Guang Zhang; Yujing Zhu; Yeping Ling; Pingbo Chen; Jiaxing Dai; Chunlei Wang; Shancai Xu; Alina Shumadalova; Huaizhang Shi

doi:10.3389/fsurg.2022.919509

Endovascular Treatment of Acute Ischemic Stroke Due to Isolated Proximal Posterior Artery Occlusion

Front Surg. 2022 May 25:9:919509. doi: 10.3389/fsurg.2022.919509. eCollection 2022.

Authors

Guang Zhang¹, Yujing Zhu¹, Yeping Ling¹, Pingbo Chen¹, Jiaxing Dai¹, Chunlei Wang¹, Shancai Xu¹, Alina Shumadalova², Huaizhang Shi¹

Affiliations

¹ Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
² Department of General Chemistry, Bashkir State Medical University, Ufa, Republic of Bashkortostan, Russia.

Abstract

Background: Acute ischemic stroke (AIS) due to isolated proximal posterior cerebral artery (PPCA) occlusion is rare but associated with high morbidity and mortality rates. However, the optimal treatment strategy for patients with AIS caused by PPCA remains unclear. We discuss our single-center experience with endovascular treatment (EVT) in patients with PPCA.

Methods: Data from patients with AIS due to PPCA occlusion were retrospectively analyzed. We analyzed procedural details, the degree of reperfusion, functional outcomes, and complications. Functional outcomes were determined using the modified Rankin Scale (mRS) at 90 days, and good outcome was defined as mRS 0-2 at 90 days. Successful reperfusion was defined as modified treatment in cerebral ischemia (mTICI) 2b-3 after endovascular therapy. Safety variables included symptomatic hemorrhage (defined as an increase of four or more points in the National Institute of Health Stroke Scale score), vessel perforation or dissection, and new ischemic stroke in different territories.

Results: Seven patients were included in this study. The mean age of the patients was 64 ± 12.4 years. Successful reperfusion was achieved in all seven patients (100%). Good outcomes were achieved at 90 days in 2 patients (28.6%), and favorable outcomes were observed in five patients (71.4%). One patient underwent angioplasty as rescue therapy after three attempts. One patient died because of severe gastrointestinal bleeding 24 h after EVT, which was probably a complication of intravenous alteplase. One patient had an embolism in the basilar artery and achieved complete reperfusion after rescue thrombectomy. Another patient had a complication of vessel dissection in the PPCA and underwent stent implantation as rescue therapy. We observed no recurrence of ischemic stroke or any intracranial hemorrhage on non-contrast computed tomography 24 h after the procedure.

Conclusion: EVT may represent an alternative treatment strategy for patients with acute ischemic stroke caused by PPCA.

Keywords: acute ischemic stroke; endovascular treatment; neurological deficit; outcome; posterior cerebral artery.