BACKGROUND AND OBJECTIVES: Endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD)–related acute large vessel occlusion (LVO) has not been established in patients with posterior circulation occlusion. This study aimed to investigate the disparities in clinical outcomes after EVT between anterior and posterior circulation ICAD-related LVO. METHODS: Using nationwide data from the retrospective multicenter registry, we conducted a post hoc analysis of 451 patients with acute ischemic stroke and ICAD-related LVO. Patients were categorized into the anterior (occlusion of the internal carotid artery or M1 or M2 segment of the middle cerebral artery) and posterior (occlusion of the basilar or intracranial vertebral arteries) groups. The primary outcome was a modified Rankin Scale score of 0 to 2 at 90 days. RESULTS: The posterior group exhibited a higher proportion of male patients, National Institute of Health Stroke Scale score, and prevalence of diabetes and hyperlipidemia. Although the onset-to-door and door-to-puncture times were comparable, the procedure time was significantly longer in the posterior group than in the anterior group (59 33-99 vs 46 29-72, P = .009). The use of stent retrievers was less frequent, and balloon angioplasty was more common in the posterior group. Adjusted analyses revealed that the posterior group had lower odds of achieving an modified Rankin Scale score of 0 to 2 at 90 days (adjusted odds ratio: 0.54, 95% CI: 0.31-0.95, P = .03) and a higher mortality rate (adjusted hazard ratio: 2.97, 95% CI: 1.27-6.95, P = .01) than the anterior group. CONCLUSION: Poorer clinical outcomes were associated with EVT for ICAD-related LVO in the posterior circulation. These findings emphasize the need to optimize treatment strategies for this patient population to improve overall prognosis.
Shirakawa et al. (Fri,) studied this question.