Intravenous Thrombolysis in Posterior Circulation Stroke

Dorňák, Tomáš; Král, Michal; Šaňák, Daniel; Kaňovský, Petr

doi:10.3389/fneur.2019.00417

Cited by 31 publications

(34 citation statements)

References 61 publications

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“…Although we recorded 7 cases with mRS 6 among ACS group compared to none among PCS group, but this difference was non-significant (p value 0.61) which is found to be in line with other studies that reported lower mortality rate among PCS compared to ACS with lack of significant difference [13,14].…”

Section: Discussionsupporting

confidence: 84%

“…Moreover, the functional outcome of the cases at discharge and 90 days was found to be better in PCS compared to ACS; 75.17% and 93.75% in PCS had mRS ≤2 in comparison to ACS that showed only 59.24% and 70% of the cases with mRS ≤2 respectively; this agrees with a systematic review performed on other retrospective published studies comparing the efficacy of IVT [12], but disagrees with another prospective cohort study that mentioned that despite mRS was lower in the posterior circulation, there was no significant difference between the two groups; this contradictory could be due to the limited sample size in the mentioned study [13] as they recruited only 30 posterior circulation and 198 anterior circulation.…”

Section: Discussionsupporting

confidence: 47%

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Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

Taha

Khawas

Tork

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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Background Intravenous thrombolysis (IVT) with alteplase is the first-line therapy for acute ischemic anterior and posterior circulation strokes (ACS and PCS). Knowledge about safety and efficacy of IVT in posterior circulation stroke is deficient as most of the Egyptian studies either assessed IVT outcome in comparison to conservative therapy or its outcome in anterior circulation stroke only. Therefore, our aim was to compare the relative frequency and outcome after intravenous thrombolysis in anterior versus posterior circulation stroke patients presenting to stroke centers of Ain Shams University hospitals (ASUH). Results A total of 238 anterior circulation stroke and 61 posterior circulation strokes were enrolled, onset-to-door and door-to-needle time were statistically insignificant. NIHSS showed comparable difference at all time points despite higher scores along anterior circulation stroke; 90-day modified Rankin Scale (mRS) showed significant improvement in both groups from mRS >2 to ≤2 with a better percentage along posterior circulation stroke patients. There was insignificant difference for either incidence of death or intracranial hemorrhage (ICH) between the two groups. Conclusion IVT significantly reduced NIHSS for both anterior and posterior circulation stroke along different studied time points. Meanwhile, a higher percentage of patients with posterior circulation stroke had a better mRS outcome at 90 days.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 47%

Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

Taha

Khawas

Tork

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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“…For ACS, knowledge on symptom onset may have outweighed the influence of the OTT on the mRS in multivariate regression analysis. For PCS, the OTT has been shown to be less crucial in thrombolysis 35 which might explain the lack of influence of known symptom onset and OTT on functional outcome in PCS patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

Herzog

Kulcsár

Luft

et al. 2021

Sci Rep

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Distinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.

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“…In scenarios with A2/3 occlusion, immediate EVT was favored only by 51% (alteplase-eligible patients)/71% (alteplaseineligible patients) of respondents, while these numbers were much higher for scenarios with M2/3 occlusion (57%/83%) and P2/3 occlusion (82/67%). The relatively high willingness to proceed with immediate EVT in P2/3 MeVOs could potentially reflect the lack of high-level evidence for IV thrombolysis in posterior circulation MeVOs, 19 though one could argue that this applies to EVT as well. In fact, the safety and efficacy of EVT has not even been formally proven for LVOs in the posterior circulation, 20 and there is complete paucity of high-level evidence on EVT for MeVOs in posterior circulation.…”

Section: Ischemic Strokementioning

confidence: 99%

Influence of intravenous alteplase on endovascular treatment decision-making in acute ischemic stroke due to primary medium-vessel occlusion: a case-based survey study

Kappelhof

Ospel

Kashani

et al. 2021

J NeuroIntervent Surg

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BackgroundIntravenous alteplase is currently the only evidence-based treatment for medium-vessel occlusion stroke (MeVO; M2/3, A2/3, and P2/3 vessel segment occlusions), but due to its limited efficacy, endovascular treatment (EVT) is increasingly performed in these patients. In this case-based survey study, we examined the influence of intravenous alteplase treatment on physicians’ decision-making for EVT in primary MeVO stroke.MethodsIn an international web-based survey among physicians involved in acute stroke care, participants provided their EVT decision for six quasi-identical fictional MeVO case scenarios (three with and without intravenous alteplase administered). Each scenario showed radiological images and clinical information in the form of a short case vignette. We compared EVT decisions (“immediate EVT”, “no EVT”, or “wait for alteplase effect” [in case scenarios with alteplase treatment only]) for case scenarios with and without alteplase treatment. Clustered multivariable logistic regression was performed to assess the effect of alteplase on treatment decision.ResultsThe survey was completed by 366 physicians from 44 countries, resulting in 2196 responses included in this study. In alteplase-treated cases, 641/1098 (58.4%) responses favored immediate EVT, (279/1098 [25.4%]) favored no EVT and 178/1098 (16.2%) opted to wait for alteplase effect. In non-alteplase-treated case scenarios, 846/1098 (78.7%) were in favor of and 252/1098 (21.3%) against EVT. Intravenous alteplase was associated with a lower chance of a decision in favor of immediate EVT (adjusted OR 0.38 [95%CI 0.31 to 0.46]).ConclusionsIntravenous alteplase is an important factor in EVT decision-making for MeVO stroke. However, even in alteplase-treated patients, more than half of the physicians decided to proceed with EVT without waiting for alteplase effect.

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Intravenous Thrombolysis in Posterior Circulation Stroke

Cited by 31 publications

References 61 publications

Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

Influence of intravenous alteplase on endovascular treatment decision-making in acute ischemic stroke due to primary medium-vessel occlusion: a case-based survey study

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