title: Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes.
abstract: OBJECTIVE
  Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes.
  
  
  METHODS
  We performed a multicenter retrospective analysis of consecutive patients with posterior circulation strokes, who underwent thrombectomy with stent retrievers or primary aspiration thrombectomy (including A Direct Aspiration First Pass Technique [ADAPT] approach). We correlated clinical and radiographic outcomes with demographic, clinical, and technical characteristics.
  
  
  RESULTS
  A total of 100 patients were included in the final analysis (mean age, 63.5±14.2 years; mean admission National Institutes of Health Stroke Scale score, 19.2±8.2). Favorable clinical outcome at 3 months (modified Rankin Scale score ≤2) was achieved in 35% of patients. Successful recanalization and shorter time from stroke onset to the start of the procedure were significant predictors of favorable clinical outcome at 90 days. Stent retriever and aspiration thrombectomy as primary treatment approaches showed comparable procedural and clinical outcomes. None of the baseline advanced imaging modalities (magnetic resonance imaging, computed tomographic perfusion, or computed tomography angiography assessment of collaterals) showed superiority in selecting patients for thrombectomy.
  
  
  CONCLUSIONS
  Time to the start of the procedure is an important predictor of clinical success after thrombectomy in patients with posterior circulation strokes. Both stent retriever and aspiration thrombectomy as primary treatment approaches are effective in achieving successful recanalization.
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.). maximmokin@gmail.com.
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Ashish
authors.initials: A
authors.lastname: Sonig
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Sananthan
authors.initials: S
authors.lastname: Sivakanthan
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Zeguang
authors.initials: Z
authors.lastname: Ren
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Adam
authors.initials: A
authors.lastname: Arthur
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Edward
authors.initials: E
authors.lastname: Duckworth
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Erol
authors.initials: E
authors.lastname: Veznedaroglu
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Mandy J
authors.initials: MJ
authors.lastname: Binning
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Liebman
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Vikas
authors.initials: V
authors.lastname: Rao
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Aquilla S
authors.initials: AS
authors.lastname: Turk
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Blaise W
authors.initials: BW
authors.lastname: Baxter
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: From the Department of Neurosurgery, University of South Florida, Tampa (M.M., S.S., Z.R.); Department of Neurosurgery, University at Buffalo, State University of New York (A.S., K.V.S., E.I.L., A.H.S.); Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (L.E., A.A., N.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, TX (P.K., E.D.); Capital Institute of Neurosciences, Capital Health Systems, Trenton, NJ (E.V., M.J.B., K.M.L., V.R.); Department of Neurosurgery and Radiology, Medical University of South Carolina, Charleston (R.D.T., A.S.T.); Department of Radiology, Erlanger Medical Center, Chattanooga, TN (B.W.B.); and Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, FL (G.D., I.L.).
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: endovascular procedures; magnetic resonance imaging; stents; stroke; thrombectomy