Treatment of posterior circulation stroke: Acute management and secondary prevention

Abstract

One fifth of strokes occur in the territory of the posterior circulation but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, have received much less attention than similar interventions for the anterior circulation. In this review we overview treatment of posterior circulation stroke, including both interventions in the acute setting and, secondary prevention. We focus on areas in which management of posterior circulation stroke differs from that of stroke in general, and highlight recent advances. Effectiveness of acute revascularisation of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower haemorrhage risks than in the anterior circulation. The recent ATTENTION and BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar artery occlusion, but its effect on other posterior occlusion sites remains uncertain. Ischaemic and haemorrhagic space-occupying cerebellar strokes can benefit from decompressive craniectomy Secondary prevention of posterior circulation strokes includes aggressive treatment of cerebrovascular risk factors with both drugs and lifestyle interventions, and short term dual antiplatelet therapy. Randomised controlled trial (RCT) data suggest basilar artery stenosis is better treated with medical therapy than stenting, which has a high peri-procedural risk. Limited data from RCTs in stenting for vertebral stenosis suggest intracranial stenosis is currently best treated with medical therapy alone; the situation for extracranial stenosis is less clear where stenting for symptomatic stenosis is an option, particularly for recurrent symptoms; larger RCTs are required in this area.

Improving neurological outcome for acute basilar artery occlusion with sufficient recanalization after thrombectomy by intraarterial tenecteplase (INSIST-IT): Rationale and design

“…The evidence to support the benefit of endovascular therapy in patients with basilar artery occlusion has only been demonstrated recently. 24,25 Two prior multicenter randomized trials did not detect favorable outcomes in BAO patients receiving EVT compared with those receiving standard medical therapy. 5,6 Two multicenter, registry studies suggested the benefit of EVT for BAO patients.…”

Posterior circulation stroke from diagnosis to management, including recent data on thrombectomy for basilar artery occlusion from the BAOCHE and ATTENTION trials

“…2 Our second review in this issue provides the latest data on management of posterior circulation stroke, both acute and secondary prevention. 3 It highlights the results from two recent trials of thrombectomy presented in May at the European Stroke Congress 2022, which both showed that thrombectomy was highly effective for BAO. 4 ATTENTION (EndovAscular TreaTmENT for acute basilar artery occlusION), the protocol paper of which is also published in this issue, 5 recruited patients within 0–12 h from the estimated time of stroke onset in China.…”

Identifying nursing interventions captured in patients with stroke by Korean nursing students: Nursing interventions classification study

“…These dysfunctions interfere with the patient's independent performance of daily activities. As a result, patients experience deterioration of activity, damage of autonomy, interpersonal relationship problem, leading to long-term depression, anxiety, and psychosocial maladjustment [3,4].…”