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To the Editor Touma et al1 reported a comprehensive systematic review and meta-analysis of 5 randomized clinical trials evaluating the benefits and risks of stent retrievers in addition to recombinant tissue plasminogen activator (rtPA) for the treatment of acute ischemic stroke (AIS). The main conclusion of the study was that “the use of stent retrievers in conjunction with rtPA vs rtPA alone is associated with significant improvement of functional independence 90 days after AIS.”1 However, as pointed out by the authors, all studies included in their meta-analysis selected only patients with anterior circulation acute ischemic strokes. Nevertheless, about 20% of all strokes and transient ischemic attacks occur in the posterior circulation arterial territory.2 Posterior circulation arterial territories have proper characteristics that differ from anterior circulatory territories.2 While the use of stents in anterior arterial territories has been showing more consistent benefits to patients,1 the use of stents in posterior arterial territories remains more problematic.3
Bianchin MM, Brondani R, Garcia de Almeida A. Stent Retrievers for Treating Anterior Circulation Acute Ischemic Stroke. JAMA Neurol. 2016;73(9):1154-1155. doi:10.1001/jamaneurol.2016.2201