{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T09:21:20Z","timestamp":1767864080141,"version":"3.49.0"},"reference-count":13,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2021,9,20]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute isolated posterior cerebral artery occlusions (aPCAOs) were excluded or under-represented in major randomized trials of mechanical thrombectomy (MT). The benefit of MT in comparison to intravenous tissue plasminogen activator (alteplase; IV-tPA) alone in these patients remains controversial and uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic search of PubMed, MEDLINE, and EMBASE databases for articles comparing MT with or without bridging IV-tPA and IV-tPA alone for aPCAO using keywords (\u2018posterior cerebral artery\u2019, \u2018thrombolysis\u2019 and \u2018thrombectomy\u2019) with Boolean operators. Extracted data from patients reported in the studies were pooled into groups (MT vs IV-tPA alone) for comparison. Estimated rates for favorable outcome (modified Rankin scale score 0\u20132), symptomatic intracranial hemorrhage (sICH), and mortality were extracted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven articles (201 MT patients, 64 IV-tPA) were included, all retrospective. There was no statistically significant difference between pooled groups in median age, median presentation National Institutes of Health Stroke Scale (NIHSS) score, PCAO segment, and median time from symptom onset to puncture or needle. The recanalization rate was significantly higher in the MT group than the IV-tPA group (85.6% vs 53.1%, p&lt;0.00001). Odds ratios for favorable outcome (OR 1.5, 95% CI 0.8 to 2.5), sICH (OR 1.1, 95%\u2009CI 0.2 to 5.5), and mortality (OR 1.4, 95%\u2009CI 0.5 to 3.6) did not significantly favor any modality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found no significant differences in odds of favorable outcome, sICH, and mortality in MT and IV-tPA in comparable aPCAO patients, despite superior MT recanalization rates. Equipoise remains regarding the optimal treatment modality for these patients.<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2021-018017","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T19:27:32Z","timestamp":1635881252000},"page":"564-567","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Mechanical thrombectomy versus intravenous alteplase alone in acute isolated posterior cerebral artery occlusion: a systematic review"],"prefix":"10.1136","volume":"14","author":[{"given":"Andre","family":"Monteiro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slah","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4500-7954","authenticated-orcid":false,"given":"Muhammad","family":"Waqas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rimal H","family":"Dossani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicco","family":"Ruggiero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nehaal M","family":"Siddiqi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ammad A","family":"Baig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2784-5957","authenticated-orcid":false,"given":"Hamid H","family":"Rai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin M","family":"Cappuzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-3724","authenticated-orcid":false,"given":"Elad I","family":"Levy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9519-0059","authenticated-orcid":false,"given":"Adnan H","family":"Siddiqui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"2024052306551177000_14.6.564.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03384.x"},{"key":"2024052306551177000_14.6.564.2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2019-015172"},{"key":"2024052306551177000_14.6.564.3","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2024052306551177000_14.6.564.4","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1001\/jamaneurol.2021.0001","article-title":"Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the TOPMOST study","volume":"78","author":"Meyer","year":"2021","journal-title":"JAMA Neurol"},{"key":"2024052306551177000_14.6.564.5","doi-asserted-by":"publisher","DOI":"10.1159\/000328229"},{"key":"2024052306551177000_14.6.564.6","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1159\/000323253","article-title":"Intravenous thrombolysis in posterior cerebral artery infarctions","volume":"31","author":"Breuer","year":"2011","journal-title":"Cerebrovasc Dis"},{"key":"2024052306551177000_14.6.564.7","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1161\/STROKEAHA.119.026907","article-title":"Thrombectomy and thrombolysis of isolated posterior cerebral artery occlusion: cognitive, visual, and disability outcomes","volume":"51","author":"Strambo","year":"2020","journal-title":"Stroke"},{"key":"2024052306551177000_14.6.564.8","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/ene.14154","article-title":"Should posterior cerebral artery occlusions be recanalized? Insights from the Trevo registry","volume":"27","author":"Claren\u00e7on","year":"2020","journal-title":"Eur J Neurol"},{"key":"2024052306551177000_14.6.564.9","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2300"},{"key":"2024052306551177000_14.6.564.10","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s00234-020-02505-w","article-title":"Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions","volume":"63","author":"Memon","year":"2021","journal-title":"Neuroradiology"},{"key":"2024052306551177000_14.6.564.11","doi-asserted-by":"crossref","DOI":"10.3171\/2021.4.FOCUS21139","article-title":"Mechanical thrombectomy versus intravenous thrombolysis for distal large-vessel occlusion: a systematic review and meta-analysis of observational studies","volume":"51","author":"Waqas","year":"2021","journal-title":"Neurosurg Focus"},{"key":"2024052306551177000_14.6.564.12","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001685"},{"key":"2024052306551177000_14.6.564.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-016-8330-x"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2021-018017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T13:55:20Z","timestamp":1716472520000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2021-018017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,2]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,5,13]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/neurintsurg-2021-018017"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2021-018017","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,2]]}}}