Abstract TP133: Efficacy Of Mechanical Thrombectomy For The Posterior Circulation Stroke

Background and Purpose: The efficacy of mechanical thrombectomy (MT) for posterior circulation large vessel occlusions has not been fully elucidated. We investigated the efficacy and safety of MT for posterior circulation stroke (PCS) compared with anterior circulation stroke (ACS). Methods: We analyzed 885 consecutive patients who underwent MT for acute ischemic stroke between January 2013 and December 2020 at six comprehensive stroke centers. The patients were divided into two groups; the PCS and ACS group. The procedural and clinical outcomes were compared between the groups. Results: A total of 767 patients (PCS group, 83; ACS group, 684), were analyzed. PCS patients were significantly younger (75 vs. 79, P = 0.008) and had a higher NIHSS score at baseline (23 vs 19, p=0.012) and longer door to puncture time (97 vs 73 min, p=0.009). The rate of male (67.0 vs 46.9% p<0.001) and atherosclerotic brain infarction (22.8 vs 8.3% p<0.001) were higher, comorbid atrial fibrillation (50.6 vs 64.4% p=0.022) was fewer in the PCA group. The rate of mTICI 3 recanalization at the first pass (40.9 vs 28.5% p=0.019) was significantly higher in the PCS group. However, the rates of final mTICI ≥ 2b recanalization (86.6 vs 83.8% p=0.491), symptomatic hemorrhagic complications, good clinical outcome at 90 days (34.3 vs 32.5% p=0.767), and mortality (22.3 vs 16% p=0.184) were similar in the groups. In the PCS group, the single use of a stent retriever for the first pass was associated with higher mortality rate compared with use of ADAPT or combined technique (38.6 vs 12.2% p=0.012). Conclusions: MT for PCS seemed to be beneficial, having similar complication, recanalization rate, and clinical outcomes with ACS.