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

Abstract

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.

Intravenous Thrombolysis in Posterior versus Anterior Circulation Stroke: Clinical Outcome Differs Only in Patients with Large Vessel Occlusion

“…In line with some previous observations, our PCS patients were younger and more often males [6,8,27,38], had less severe baseline NIHSS scores [7,8,10,[12][13][14]38,39], lower occurrence of atrial fibrillation [6,[8][9][10]15,27,38,39], higher blood glucose levels [6,8,15] and slower ONT and DNT [8,13] in comparison to ACS patients. The reported occurrence of other conventional stroke risk factors, clinical parameters, and prophylactic treatment recorded at admission or discharge in both groups has varied widely across studies with diverse degrees of statistical significance.…”

“…Historically, patients with PCS have been thought to have a poorer outcome with high morbidity and mortality [47,48], but latter studies have shown the opposite to be true. Most of the studies have found that the 3-month outcomes after IVT treatment alone in patients with PCS were better or very much alike to ACS patients, including the significantly more frequent achievement of both excellent (55.7 vs. 41.6% [15] and 45.2 vs. 37.5% [8]) and good (63.9 vs. 53.0% [15], 61.3 vs. 49.4% [8] and 93.8 vs. 70.2% [14], respectively) outcomes. These results run parallel with our findings.…”

“…PCS represents 12-19% of all IVT-treated strokes [6][7][8][9] and it is even more frequent in the non-IVT population (20-26%) [6]. Although data from real-world registries and observational studies have indicated that patients with PCS might benefit from IVT, analyzed numbers have been small (30 to 124) and the results controversial [6][7][8][10][11][12][13][14][15]. Therefore, it remains unclear whether outcomes in AIS patients treated with IVT can be influenced based on the affected vascular territory.…”