Abstract
PCA stroke was under-represented in or excluded from the clinical trials examining thrombolysis based on the PWI-DWI mismatch concept. We present 6 patients with PCA stroke treated with thrombolysis in an extended time window by using MR imaging criteria. Symptoms included aphasia, sensorimotor hemiparesis, hemineglect, and homonymous hemianopia. Initial MR imaging demonstrated circumscribed ischemic lesions in the thalamus or hippocampus; MR angiography showed PCA occlusion with corresponding hypoperfusion. Follow-up MR imaging showed partial/complete recanalization in 4 patients with minor infarction growth, while in 1 patient, PCA occlusion persisted, resulting in a large PCA infarction. Three patients improved within 2 hours; at discharge, homonymous hemianopia had resolved in 3 patients. At 3-month follow-up, 4 patients had an mRS score of 0 or 1. These results support the approach to treat patients with PCA stroke with thrombolysis based on the mismatch concept. Because rehabilitation options for hemianopia are limited, thrombolysis may enhance the chance of a favorable outcome.
Highlights
We report a case series of 6 patients with acute ischemic stroke in the PCA territory treated with intravenous thrombolysis in an extended time window based on the DWI-PWI-mismatch concept
Materials and Methods From a prospectively collected stroke unit registry, we identified 5948 patients with acute ischemic stroke admitted between January 2004 and December 2009
818 (13.8%) patients were treated with rtPA; among these, 71 (8.7%) patients received intravenous thrombolysis (0.9-mg/kg rtPA; maximum, 90 mg; with 10% of the dose given as a bolus followed by an infusion lasting 60 minutes) in an extended time window guided by acute stroke MR imaging based on the DWI-PWI mismatch concept
Summary
From a prospectively collected stroke unit registry, we identified 5948 patients with acute ischemic stroke admitted between January 2004 and December 2009. 818 (13.8%) patients were treated with rtPA; among these, 71 (8.7%) patients received intravenous thrombolysis (0.9-mg/kg rtPA; maximum, 90 mg; with 10% of the dose given as a bolus followed by an infusion lasting 60 minutes) in an extended time window guided by acute stroke MR imaging based on the DWI-PWI mismatch concept. Treatment was performed on an individual off-label-use basis with patient informed consent documented according to ethics committee approval. Six of the 71 (8.5%) patients had acute ischemic stroke in the PCA territory. All clinical data and technical investigations were collected and documented according to a standardized acute stroke care protocol. Initial and follow-up MR imaging was performed on a 1.5T sys-
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