BACKGROUND Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies. OBJECTIVE To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. METHODS In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6). RESULTS We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P < .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P < .01) and lower rates of good outcomes (31% vs 43%, P < .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only. CONCLUSION Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large "real-world" retrospective study.

中文翻译：

---

血栓切除技术可预测后循环卒中的结果——来自 STAR 合作的见解

背景 评估急性缺血性卒中机械取栓 (MT) 的随机对照试验主要研究前循环患者。尚未在大型队列研究中评估后循环患者结果的程序和临床预测因素。目的 在比较不同的前线取栓技术的同时，研究后循环 MT 后功能独立的技术和临床预测因素。方法 在一项对 2014 年 6 月至 2018 年 12 月 6 日至 2018 年 12 月期间因卒中接受 MT 的 3045 名患者进行的回顾性多中心国际研究中，345 名患者患有后循环卒中。MT 使用抽吸、支架取出器或联合方法进行。使用 90 天改良 Rankin 评分评估功能结果，分为良好 (0-2) 和不良结果 (3-6)。结果 我们纳入了 2700 名前循环卒中患者和 345 名后循环卒中患者。后路患者（年龄：60 ± 14，46% 女性）主要表现为基底动脉闭塞 (80%)，并使用接触抽吸或 ADAPT (39%)、支架取出器 (31%) 或联合方法 (19%) 进行治疗。与前路卒中相比，后路卒中的治疗延迟（500 分钟 vs 340 分钟，P < .001）、美国国立卫生研究院卒中量表（NIHSS）较高（17.1 对 15.7，P < .01）和良好结局率较低（31 % 与 43%，P < .01）。在后路 MT 中，糖尿病 (OR = 0.28, 95%CI: 0.12-0.65)、入院 NIHSS (OR = 0.9, 95%CI: 0.86-0.94) 和支架取栓器的使用 (OR = 0.26, 95%CI: 0.11) -0.62) 或联合方法 (OR = 0.35, 95%CI: 0.12-1.01) 与 ADAPT 与良好结果的较低几率相关。与 ADAPT 相比，使用支架取出器与良好结果的几率较低相关，即使包括仅基底闭塞或仅成功再通的患者也是如此。结论 尽管安全性相似，但在大型“真实世界”回顾性研究中，与支架取栓器或联合方法相比，使用 ADAPT 与后循环血栓切除术后更高的功能独立率相关。