Abstract
Background: Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS). PCIS is a clinical syndrome associated with ischemia-related changes in the territory of the posterior circulation arteries. Embolism is the most common stroke mechanism in posterior circulation. PCIS represents 12–19% of all IVT-treated strokes.Methods and Results: We searched the PubMed database for assessments of intracerebral hemorrhage (ICH) and clinical outcome in PCIS patients treated with IVT. ICH occurs in 0–6.9% of posterior ischemic stroke depending on the definition of symptomatic ICH, and any ICH in 17–23.4% of posterior ischemic stroke. For patients with PCIS, 38–49% have a favorable outcome (mRS 0–1) after IVT. Better clinical outcomes occur more often in patients with PCIS than in those with ACIS. The mortality rate among PCIS patients treated with IVT ranges from 9 to 19%; it does not differ significantly between PCIS and ACIS.Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset.
Highlights
History of Intravenous Thrombolysis—The Most Relevant StudiesIntravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS)
Studies by the National Institute of Neurological Disorders and Stroke (NINDS) and Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke A + B (ATLANTIS) demonstrated improvements in functional outcomes at 3 months if thrombolysis was administered within 3 h of symptom onset, with the greatest benefit seen within 90 min from symptom onset [4, 5]
Both Face Arm Speech Test (FAST) and ABCD2 scores, which have been developed as screening tools for unselected strokes, are less effective in the diagnosis and identification of high-risk cases for PCIS and transitory ischemic attack (TIA) [14].The Recognition of Stroke In the Emergency Room (ROSIER) scale seems to be more sensitive to marking PCIS as a potential stroke, because this scale includes a visual field defects evaluation [29]
Summary
History of Intravenous Thrombolysis—The Most Relevant StudiesIntravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS). At the beginning of the rtPA era (1992/1993), three smallplacebo-controlled studies reported its efficacy in the early stages of ischemic stroke [1,2,3]. Three much largerplacebo-controlled trials showed the benefits of intravenous rtPA given to patients with ischemic stroke selected by clinical symptoms and CT. Studies by the National Institute of Neurological Disorders and Stroke (NINDS) and Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke A + B (ATLANTIS) demonstrated improvements in functional outcomes at 3 months if thrombolysis was administered within 3 h of symptom onset, with the greatest benefit seen within 90 min from symptom onset [4, 5]. Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS).
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call