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Open AccessArticle

Peripheral Artery Disease among a High-Risk Asian Population with Ischaemic Stroke, Cardiovascular Disease, or Diabetes Mellitus

by Narayanaswamy Venketasubramanian, Koon Hou Mak, Keh Chuan Loh and John Tan

J. Clin. Med. 2024, 13(13), 3657; https://doi.org/10.3390/jcm13133657 - 22 Jun 2024

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Abstract

Background: Peripheral artery disease (PAD) affects more than 100 million people globally. Most PAD studies have been performed among predominantly White populations—less is known about other ethnicities. The aim of this cross-sectional study was to determine the prevalence and risk factors of PAD [...] Read more.

Background: Peripheral artery disease (PAD) affects more than 100 million people globally. Most PAD studies have been performed among predominantly White populations—less is known about other ethnicities. The aim of this cross-sectional study was to determine the prevalence and risk factors of PAD in a high-risk Asian population with ischaemic stroke (IS), myocardial infarction, unstable angina (CVD), or diabetes mellitus (DM). Methods: Patients admitted for IS, CVD, or DM were recruited. Data were collected on age, sex, body mass index (BMI), index condition (CVD, IS, DM), history of hypertension, DM, hypercholesterolaemia, cigarette smoking, and claudication. The Edinburgh Claudication Questionnaire was administered, the ankle brachial index (ABI) was determined, and PAD was diagnosed if ABI was ≤0.9. Results: Of the 450 subjects recruited, 150 were placed in each index disease group, the mean age was 61.9 ± 10.32 years, 43.1% were female, and the mean BMI was 23.9 ± 4.3. Hypertension was reported in 59.3%, DM in 63.6%, hypercholesterolaemia in 39.6%, and smoking in 42.9% of patients. The prevalence of PAD was 27.1%, 22.0% in IS, 29.3% in CAD, and 30.0% in DM. PAD was associated with increasing age (adjusted odds ratio (aOR) 1.04/year, 95% confidence interval [CI] 1.01–1.06; p < 0.001), reduced BMI (aOR 0.94, 95% CI 0.89–0.99; p = 0.026), DM (aOR 1.59, 95% CI 1.20–3.18; p = 0.007), and hypercholesterolaemia (aOR 1.82, 95% CI 1.17–2.28; p = 0.007). It was more frequent in non-lacunar versus lacunar acute IS, non-ST segment elevation versus ST-segment elevation acute myocardial infarction, and insulin-treated versus non-insulin-treated DM. Conclusions: Our study showed a high prevalence of PAD among high-risk Asian patients. This was associated with increasing age, DM, and hypercholesterolaemia and inversely associated with BMI. Different rates were found in sub-groups of IS, CVD, and DM. Systematic approaches were used to identify these high-risk individuals and to improve their outcomes. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

15 pages, 1238 KiB

Open AccessArticle

Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

by Mahsa Mojtahedi, Agnetha E. Bruggeman, Henk van Voorst, Elena Ponomareva, Manon Kappelhof, Aad van der Lugt, Jan W. Hoving, Bruna G. Dutra, Diederik Dippel, Fabiano Cavalcante, Lonneke Yo, Jonathan Coutinho, Josje Brouwer, Kilian Treurniet, Manon L. Tolhuisen, Natalie LeCouffe, Nerea Arrarte Terreros, Praneeta R. Konduri, Wim van Zwam, Yvo Roos, Charles B. L. M. Majoie, Bart J. Emmer and Henk A. Marquering Show full author list Hide full author list

J. Clin. Med. 2024, 13(5), 1388; https://doi.org/10.3390/jcm13051388 - 28 Feb 2024

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Abstract

(1) Background: For acute ischemic strokes caused by large vessel occlusion, manually assessed thrombus volume and perviousness have been associated with treatment outcomes. However, the manual assessment of these characteristics is time-consuming and subject to inter-observer bias. Alternatively, a recently introduced fully [...] Read more.

(1) Background: For acute ischemic strokes caused by large vessel occlusion, manually assessed thrombus volume and perviousness have been associated with treatment outcomes. However, the manual assessment of these characteristics is time-consuming and subject to inter-observer bias. Alternatively, a recently introduced fully automated deep learning-based algorithm can be used to consistently estimate full thrombus characteristics. Here, we exploratively assess the value of these novel biomarkers in terms of their association with stroke outcomes. (2) Methods: We studied two applications of automated full thrombus characterization as follows: one in a randomized trial, MR CLEAN-NO IV (n = 314), and another in a Dutch nationwide registry, MR CLEAN Registry (n = 1839). We used an automatic pipeline to determine the thrombus volume, perviousness, density, and heterogeneity. We assessed their relationship with the functional outcome defined as the modified Rankin Scale (mRS) at 90 days and two technical success measures as follows: successful final reperfusion, which is defined as an eTICI score of 2b-3, and successful first-pass reperfusion (FPS). (3) Results: Higher perviousness was significantly related to a better mRS in both MR CLEAN-NO IV and the MR CLEAN Registry. A lower thrombus volume and lower heterogeneity were only significantly related to better mRS scores in the MR CLEAN Registry. Only lower thrombus heterogeneity was significantly related to technical success; it was significantly related to a higher chance of FPS in the MR CLEAN-NO IV trial (OR = 0.55, 95% CI: 0.31–0.98) and successful reperfusion in the MR CLEAN Registry (OR = 0.88, 95% CI: 0.78–0.99). (4) Conclusions: Thrombus characteristics derived from automatic entire thrombus segmentations are significantly related to stroke outcomes. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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10 pages, 1163 KiB

Open AccessArticle

The Stream Device—A Retrospective Review of 51 Cases

by Karlis Kupcs, Patricija Sproge, Katrina Kupca and Pervinder Bhogal

J. Clin. Med. 2023, 12(19), 6384; https://doi.org/10.3390/jcm12196384 - 6 Oct 2023

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Abstract

Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. Materials and Methods: We performed [...] Read more.

Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. Materials and Methods: We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. Results: We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51–89) and a median NIHSS score of 17 (range 4–22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6–10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2–26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0–10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). Conclusions: The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device’s use. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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11 pages, 486 KiB

Open AccessArticle

Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study

by Aleksandra Ekkert, Daiva Milmantienė, Unė Jokimaitytė and Dalius Jatužis

J. Clin. Med. 2023, 12(16), 5181; https://doi.org/10.3390/jcm12165181 - 9 Aug 2023

Cited by 1 | Viewed by 945

Abstract

Background. Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. Methods. We conducted a retrospective analysis of the [...] Read more.

Background. Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. Methods. We conducted a retrospective analysis of the data from 500 subjects admitted to the tertiary stroke centre’s emergency department between 2018 and 2020 due to PCS. Demographic and clinical factors were analysed among three groups: the RT group, the group with no RT because of absolute contraindications (ACI), and the group with no RT because of relative contraindications (RCI). Results. Of the patients, 202 (40.3%) were female. The median NIHSS was four (4), and the subjects’ median age was 69 (18). RT was performed on 120 (24%) subjects. FAST symptoms (OR—5.62, 95% CI [2.90–12.28]) and higher NIHSS (OR—1.13, 95% CI [1.09–1.18]) at presentation, atrial fibrillation (OR—1.56, 95% CI [1.02–2.38]), hypertension (OR—2.19, 95% CI [1.17–4.53]) and diabetes (OR—1.70, 95% CI [1.06–2.71]) increased the chance of RT. Late arrival was the most prevalent ACI for 291 (58.2%) patients. FAST-negative subjects (OR—2.92, 95% CI [1.84–4.77]) and males (OR—1.58, 95% CI [1.11–2.28]) had a higher risk of arriving late. Because of RCI, 50 (10%) subjects did not receive RT; the majority were above 80 and had NIHSS ≤ 5. Subjects with RCI who received the RT had a higher NIHSS (4 vs. 3, p < 0.001), higher hypertension (59 (92.2%) vs. 35 (77.8%), p = 0.032) and heart failure (23 (35.9%) vs. 7 (15.6%), p = 0.018) prevalence. There was a trend for less RT in females with RCI. Conclusions. Late arrival was the most common barrier to RT, and the male gender increased this risk. because of relative contraindications, 10% of subjects were not considered for RT. The presence of FAST symptoms, vascular risk factors, and a higher NIHSS increased the chance of RT. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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13 pages, 994 KiB

Open AccessArticle

Association between Triglyceride-Glucose Index and Early Neurological Outcomes after Thrombolysis in Patients with Acute Ischemic Stroke

by Baixiang Zhang, Hanhan Lei, Gareth Ambler, David J. Werring, Shuangfang Fang, Hangfeng Li, Ronghua Chen, Jin Wei, Guangliang Chen, Nan Liu and Houwei Du

J. Clin. Med. 2023, 12(10), 3471; https://doi.org/10.3390/jcm12103471 - 15 May 2023

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Abstract

Background: The triglyceride-glucose (TyG) index is a novel biomarker of insulin resistance which might plausibly influence endogenous fibrinolysis and thus early neurological outcomes in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis using recombinant tissue-plasminogen activator. Methods: We included consecutive AIS [...] Read more.

Background: The triglyceride-glucose (TyG) index is a novel biomarker of insulin resistance which might plausibly influence endogenous fibrinolysis and thus early neurological outcomes in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis using recombinant tissue-plasminogen activator. Methods: We included consecutive AIS patients within 4.5 h of symptom onset undergoing intravenous thrombolysis between January 2015 and June 2022 in this multi-center retrospective observational study. Our primary outcome was early neurological deterioration (END), defined as ≥2 (END₂) or ≥ 4 (END₄) National Institutes of Health Stroke Scale (NIHSS) score worsening compared to the initial NIHSS score within 24 h of intravenous thrombolysis. Our secondary outcome was early neurological improvement (ENI), defined as a lower NIHSS score at discharge. TyG index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. We evaluated the association of END and ENI with TyG index using a logistic regression model. Results: A total of 676 patients with AIS were evaluated. The median age was 68 (Interquartile range, IQR (60–76) years old), and 432 (63.9%) were males. A total of 89 (13.2%) patients developed END₂, 61 (9.0%) patients developed END₄, and 492 (72.7%) experienced ENI. In multivariable logistic regression analysis, after adjustment for confounding factors, TyG index was significantly associated with increased risks of END₂ (categorical variable, vs. lowest tertile, medium tertile odds ratio [OR] 1.05, 95% confidence interval, CI 0.54–2.02, highest tertile OR 2.94, 95%CI 1.64–5.27, overall p < 0.001) and END₄ (categorical variable, vs. lowest tertile, medium tertile OR 1.21, 95%CI 0.54–2.74, highest tertile OR 3.80, 95%CI 1.85–7.79, overall p < 0.001), and a lower probability of ENI (categorical variable, vs. lowest tertile, medium tertile OR 1.00, 95%CI 0.63–1.58, highest tertile OR 0.59, 95%CI 0.38–0.93, overall p = 0.022). Conclusions: Increasing TyG index was associated with a higher risk of END and a lower probability of ENI in patients with acute ischemic stroke treated with intravenous thrombolysis. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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10 pages, 1011 KiB

Open AccessArticle

Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion

by Karissa C Arthur, Shenwen Huang, Julie C. Gudenkauf, Alireza Mohseni, Richard Wang, Alperen Aslan, Mehreen Nabi, Meisam Hoseinyazdi, Brenda Johnson, Navangi Patel, Victor C Urrutia and Vivek Yedavalli

J. Clin. Med. 2023, 12(10), 3374; https://doi.org/10.3390/jcm12103374 - 9 May 2023

Cited by 2 | Viewed by 1607

Abstract

Background: The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity which has also been shown to accurately predict large vessel occlusions (LVOs). However, to date there is no study exploring whether LAMS correlates with the computed [...] Read more.

Background: The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity which has also been shown to accurately predict large vessel occlusions (LVOs). However, to date there is no study exploring whether LAMS correlates with the computed tomography perfusion (CTP) parameters in LVOs. Methods: Patients with LVO between September 2019 and October 2021 were retrospectively reviewed and included if the CTP data and admission neurologic exams were available. The LAMS was documented based on emergency personnel exams or scored retrospectively using an admission neurologic exam. The CTP data was processed by RAPID (IschemaView, Menlo Park, CA, USA) with an ischemic core volume (relative cerebral blood flow [rCBF] < 30%), time-to-maximum (Tmax) volume (Tmax > 6 s delay), hypoperfusion index (HI), and cerebral blood volume (CBV) index. Spearman’s correlations were performed between the LAMS and CTP parameters. Results: A total of 85 patients were included, of which there were 9 intracranial internal carotid artery (ICA), 53 proximal M1 branch middle cerebral artery M1, and 23 proximal M2 branch occlusions. Overall, 26 patients had LAMS 0–3, and 59 had LAMS 4–5. In total, LAMS positively correlated with CBF < 30% (Correlation Coefficient (CC): 0.32, p < 0.01), Tmax > 6 s (CC:0.23, p < 0.04), HI (CC:0.27, p < 0.01), and negatively correlated with the CBV index (CC:−0.24, p < 0.05). The relationships between LAMS and CBF were < 30% and the HI was more pronounced in M1 occlusions (CC:0.42, p < 0.01; 0.34, p < 0.01 respectively) and proximal M2 occlusions (CC:0.53, p < 0.01; 0.48, p < 0.03 respectively). The LAMS also correlated with a Tmax > 6 s in M1 occlusions (CC:0.42, p < 0.01), and negatively correlated with the CBV index in M2 occlusions (CC:−0.69, p < 0.01). There were no significant correlations between the LAMS and intracranial ICA occlusions. Conclusions: The results of our preliminary study indicate that the LAMS is positively correlated with the estimated ischemic core, perfusion deficit, and HI, and negatively correlated with the CBV index in patients with anterior circulation LVO, with stronger relationships in the M1 and M2 occlusions. This is the first study showing that the LAMS may be correlated with the collateral status and estimated ischemic core in patients with LVO. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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11 pages, 2927 KiB

Open AccessArticle

Shoulder Joint Hybrid Assistive Limb Treatment for Chronic Stroke Patients with Upper Limb Dysfunction

by Masakazu Taketomi, Yukiyo Shimizu, Hideki Kadone, Shigeki Kubota, Yuta Kagai, Yoshitaka Okamoto, Yasushi Hada and Masashi Yamazaki

J. Clin. Med. 2023, 12(3), 1215; https://doi.org/10.3390/jcm12031215 - 3 Feb 2023

Cited by 1 | Viewed by 1589

Abstract

Upper extremity dysfunction after stroke affects quality of life. Focusing on the shoulder joint, we investigated the safety and effectiveness of rehabilitation using a shoulder joint hybrid assistive limb (HAL). Eight patients with chronic stroke and upper extremity functional disability were enrolled and [...] Read more.

Upper extremity dysfunction after stroke affects quality of life. Focusing on the shoulder joint, we investigated the safety and effectiveness of rehabilitation using a shoulder joint hybrid assistive limb (HAL). Eight patients with chronic stroke and upper extremity functional disability were enrolled and used a shoulder joint HAL, which assisted shoulder movement based on the user’s intention, through myoelectric activation of the shoulder flexor. Ten training sessions of 30–40 min each were performed to assist voluntary movement of upper limb elevation on the affected side through triggering the deltoid muscle. All patients completed the interventions without shoulder pain. Surface electromyography evaluation indicated post-intervention improvement in coordinated movement of the affected upper extremity. Significant improvements in voluntary and passive shoulder joint range of motion were obtained after the intervention, suggesting improvement in shoulder muscle strength. A significant decrease in the modified Ashworth scale and improvements in functional scores in the upper limb were also observed. Along with safe use for our study patients, the shoulder HAL provided appropriate motor learning benefits. Improvements in shoulder joint function and whole upper limb function were observed, suggesting that HAL could be an optimal treatment method. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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13 pages, 1200 KiB

Open AccessArticle

Impact of Traditional and Non-Traditional Lipid Parameters on Outcomes after Intravenous Thrombolysis in Acute Ischemic Stroke

by Chua Ming, Emma M. S. Toh, Qai Ven Yap, Leonard L. L. Yeo, Ching-Hui Sia, Andrew F. W. Ho, Yiong Huak Chan, Fathima Ashna Nastar, Amanda Y. L. Lim and Benjamin Y. Q. Tan

J. Clin. Med. 2022, 11(23), 7148; https://doi.org/10.3390/jcm11237148 - 1 Dec 2022

Cited by 2 | Viewed by 1785

Abstract

Contradicting evidence exists regarding the role of lipids in outcomes following intravenous (IV) thrombolysis with tissue plasminogen activator (tPA). Restricted cubic spline curves and adjusted logistic regression were used to evaluate associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol [...] Read more.

Contradicting evidence exists regarding the role of lipids in outcomes following intravenous (IV) thrombolysis with tissue plasminogen activator (tPA). Restricted cubic spline curves and adjusted logistic regression were used to evaluate associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C ratio with poor functional outcome, symptomatic intracranial hemorrhage (SICH) and 90-day mortality, among 1004 acute ischemic stroke (AIS) patients who received IV tPA in a comprehensive stroke center. Quartile (Q) 1, Q2 and Q3 of HDL-C were associated with increased odds of poor functional outcome (adjusted odds ratio (adjOR) 1.66, 95% CI 1.06–2.60, p = 0.028, adjOR 1.63, 95% CI 1.05–2.53, p = 0.027, adjOR 1.56, 95% CI 1.01–2.44, p = 0.048) compared to Q4. Q2 and Q4 of non-HDL-C were associated with increased odds of SICH (adjOR 4.28, 95% CI 1.36–18.90, p = 0.025, adjOR 5.17, 95% CI 1.64–22.81, p = 0.011) compared to Q3. Q1 and Q2 of LDL-C was associated with increased odds of mortality (adjOR 2.57, 95% CI 1.27–5.57, p = 0.011 and adjOR 2.28, 95% CI 1.10–5.02, p = 0.032) compared to Q3. In AIS patients who received IV tPA, low LDL-C was associated with increased odds of mortality while HDL-C may be protective against poor functional outcome. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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17 pages, 832 KiB

Open AccessSystematic Review

Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials

by Joana Teodoro, Sónia Fernandes, Cidália Castro and Júlio Belo Fernandes

J. Clin. Med. 2024, 13(5), 1358; https://doi.org/10.3390/jcm13051358 - 27 Feb 2024

Cited by 1 | Viewed by 2198

Abstract

Background: Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify [...] Read more.

Background: Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify current trends in gait rehabilitation for stroke survivors. Methods: The review followed the methodological framework suggested by Arksey and O’Malley. Electronic databases, such as CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection, were systematically searched in November 2023. Inclusion criteria comprised papers published in either English or Portuguese from 2013 to 2023. Results: From the initial search, a total of 837 papers were identified; twenty-one papers were incorporated into this review. Thirteen distinct categories of gait rehabilitation interventions were identified, encompassing diverse approaches. These categories comprise conventional rehabilitation exercises, traditional gait training with integrated technology, and gait training supported by modern technologies. Conclusions: Although traditional rehabilitation exercises have historically proven effective in aiding stroke survivors, a recent trend has emerged, emphasizing the development and integration of innovative therapeutic approaches that harness modern technologies. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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24 pages, 1074 KiB

Open AccessSystematic Review

Functional and Mortality Outcomes with Medical and Surgical Therapy in Malignant Posterior Circulation Infarcts: A Systematic Review

by Nicole-Ann Lim, Hong-Yi Lin, Choon Han Tan, Andrew F. W. Ho, Tseng Tsai Yeo, Vincent Diong Weng Nga, Benjamin Y. Q. Tan, Mervyn J. R. Lim and Leonard L. L. Yeo

J. Clin. Med. 2023, 12(9), 3185; https://doi.org/10.3390/jcm12093185 - 28 Apr 2023

Cited by 2 | Viewed by 1255

Abstract

Background: There remains uncertainty regarding optimal definitive management for malignant posterior circulation infarcts (MPCI). While guidelines recommend neurosurgery for malignant cerebellar infarcts that are refractory to medical therapy, concerns exist about the functional outcome and quality of life after decompressive surgery. Objective: This [...] Read more.

Background: There remains uncertainty regarding optimal definitive management for malignant posterior circulation infarcts (MPCI). While guidelines recommend neurosurgery for malignant cerebellar infarcts that are refractory to medical therapy, concerns exist about the functional outcome and quality of life after decompressive surgery. Objective: This study aims to evaluate the outcomes of surgical intervention compared to medical therapy in MPCI. Methods: In this systematic review, MEDLINE, Embase and Cochrane databases were searched from inception until 2 April 2021. Studies were included if they involved posterior circulation strokes treated with neurosurgical intervention and reported mortality and functional outcome data. Data were collected according to PRISMA guidelines. Results: The search yielded 6677 studies, of which 31 studies (comprising 723 patients) were included for analysis. From the included studies, we found that surgical therapy led to significant differences in mortality and functional outcomes in patients with severe disease. Neurological decline and radiological criteria were often used to decide the timing for surgical intervention, as there is currently limited evidence for preventative neurosurgery. There is also limited evidence for the superiority of one surgical modality over another. Conclusion: For patients with MPCI who are clinically stable at the time of presentation, in terms of mortality and functional outcome, surgical therapy appears to be equivocal to medical therapy. Reliable evidence is lacking, and further prospective studies are rendered. Full article

(This article belongs to the Special Issue Clinical Evaluation, Treatment and Prognostication of Ischemic Stroke Patients)

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