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

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 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.

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

“…Although PCS's chances of symptomatic intracerebral hemorrhaging are inferior to ACS, the perennial challenge of weighing RT risks against its benefits remains, especially when confronted with low NIHSS readings [67]. In such scenarios, decision-making often leans on nuanced, frequently subjective indicators that might not be explicitly addressed in standardized guidelines [68].…”