Endovascular Treatment for Posterior Circulation Stroke: Ways to Maximize Therapeutic Efficacy

The efficacy of endovascular treatment (EVT) in patients with posterior circulation stroke has not been proven. Two recent randomized controlled trials failed to show improved functional outcomes after EVT for posterior circulation stroke (PC-EVT). However, promising results for two additional randomized controlled trials have also been presented at a recent conference. Studies have shown that patients undergoing PC-EVT had a higher rate of futile recanalization than those undergoing EVT for anterior circulation stroke. These findings call for further identification of prognostic factors beyond recanalization. The significance of baseline clinical severity, infarct volume, collaterals, time metrics, core-penumbra mismatch, and methods to accurately measure these parameters are discussed. Furthermore, their interplay on EVT outcomes and the potential to individualize patient selection for PC-EVT are reviewed. We also discuss technical considerations for improving the treatment efficacy of PC-EVT.

Automated summary

The efficacy of endovascular treatment (EVT) in posterior circulation stroke (PC-EVT) is still uncertain. While some studies have shown no improvement in functional outcomes with EVT for PC-EVT, there are promising results from recent trials. Factors such as baseline clinical severity, infarct volume, collaterals, and time metrics need to be further studied to identify prognostic factors beyond recanalization. Additionally, individualized patient selection for PC-EVT and technical considerations for improving treatment efficacy are discussed.