Thrombolysis in Posterior Circulation Stroke: Stroke Subtypes and Patterns, Complications and Outcome

Abstract

Background: Patients with posterior circulation stroke (PCS) were underrepresented in or even excluded from the large clinical trials investigating acute therapy with thrombolysis. Therefore, the knowledge about potential benefits and risks of thrombolysis in PCS is sparse. Methods: From July 2004 until June 2007, 237 stroke patients were treated with thrombolysis within 3 h after onset of symptoms in our stroke unit. Baseline characteristics, etiology, CT/MRI stroke patterns, clinical outcome, and complications of patients with PCS were compared to those with anterior circulation stroke (ACS). Results: There were 30 patients in the PCS group; 198 had ACS. In the PCS group, less patients had a history of prior stroke (0/30 vs. 31/198 (15.7%), p = 0.02) and less were treated with platelet inhibitors (6/30 (20.0%) vs. 83/198 (41.9%), p = 0.02). Onset to treatment time was higher in the PCS group (156.2 ± 23.2 vs. 141.1 ± 30.7, p = 0.01). Small vessel disease occurred more often in PCS patients (10/30 (33.3%) vs. 12/198 (6.1%), p < 0.001), whereas stroke of undetermined cause was less frequent (5/30 (16.7%) vs. 75/198 (37.9%), p = 0.02). Correspondingly, PCS patients had more lacunar (13/30 (43.3%) vs. 15/198 (7.3%), p < 0.001) strokes on CT/MRI. Patients with PCS had significantly lower median NIHSS scores after 2 and 24 h, whereas the median NIHSS and mRS scores at discharge as well as the mRS score at the 3-month follow-up, although still lower, did not differ significantly between both groups. Outcome was similar with regard to complications and mortality. Conclusions: Patients with PCS have a higher rate of small vessel disease and lacunar stroke. In terms of potential benefits and risks of thrombolysis, we could demonstrate no significant differences between PCS and ACS. Acute PCS patients should be diagnosed and treated with the same elaborateness as ACS patients.

Posterior circulation ischaemic stroke

“…33 34 Case series have shown prolonged door to needle time in patients with posterior circulation stroke; one observational study of 237 patients showed a mean time of 156.2 min (standard deviation 23.2) in the posterior circulation group versus 141.1 min (30.7) in the anterior circulation group; P=0.01. 33 Another study showed a prolonged door to needle time, but no prolonged stroke specialist to needle time. 34 As with anterior circulation events, the administration of tPA in the posterior circulation carries a risk of haemorrhage, anaphylaxis, or angio-oedema.…”

Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery

“…Ischemic strokes in the anterior circulation of undefined pathogenesis have previously been reported to cause a more severe impairment compared with ischemic strokes in the posterior circulation. [23][24][25] A 10-fold amount of patients with sVAD experienced an SAH compared with patients with sICAD. Most of them affected either only the intracranial segment of the vertebral artery or extended to the intracranial segments.…”

Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1)

“…Several population- and hospital-based registries in Caucasian and Asian populations consistently showed that compared to anterior circulation strokes (ACS), patients with posterior circulation stroke (PCS) were younger and more commonly male. These patients more frequently had small penetrating artery disease, smoked tobacco and had diabetes mellitus, while they less frequently had cardio-embolic stroke aetiologies, atrial fibrillation, valvular heart disease and hypertension [1,3,6,7,8,9,10,11,12,13]. Large artery disease was more frequent in patients with PCS according to some studies [12,13,14] and less frequent in patients with PCS according to some others [3,11].…”

“…These patients more frequently had small penetrating artery disease, smoked tobacco and had diabetes mellitus, while they less frequently had cardio-embolic stroke aetiologies, atrial fibrillation, valvular heart disease and hypertension [1,3,6,7,8,9,10,11,12,13]. Large artery disease was more frequent in patients with PCS according to some studies [12,13,14] and less frequent in patients with PCS according to some others [3,11]. All of these registries included predominantly older patients (between 61 and 72 years) [1,2,3,4,5,6,7,8,9,10,11,12,15].…”

“…Large artery disease was more frequent in patients with PCS according to some studies [12,13,14] and less frequent in patients with PCS according to some others [3,11]. All of these registries included predominantly older patients (between 61 and 72 years) [1,2,3,4,5,6,7,8,9,10,11,12,15]. …”