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Prehospital Thrombolysis: A Manual from Berlin
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Less thrombolysis in posterior circulation infarction-a necessary evil?

K M Sand1, H Naess2,3, R M Nilsen4

  • 1Department of Neurology, Institute for Clinical Medicine, University of Bergen, Bergen, Norway.

Acta Neurologica Scandinavica
|July 7, 2016
PubMed
Summary

Patients with posterior circulation infarction (PCI) present with subtler symptoms and have a delayed hospital arrival compared to anterior circulation infarction (ACI). Despite this, PCI patients are younger and experience better outcomes, though they receive thrombolysis less often.

Keywords:
cerebrovascular diseasescritical carestroketreatment

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Posterior circulation infarction (PCI) often presents with subtle symptoms, potentially delaying diagnosis and acute intervention.
  • Understanding the clinical characteristics and outcomes of PCI is crucial for optimizing patient management.

Purpose of the Study:

  • To comprehensively describe the clinical presentation, management strategies, and patient outcomes for posterior circulation infarction (PCI) within the NORSTROKE registry.
  • To compare PCI cases with anterior circulation infarction (ACI) to identify key differences in presentation and treatment.

Main Methods:

  • Retrospective analysis of 686 patients with PCI admitted to Haukeland University Hospital between 2006-2013, registered in the NORSTROKE database.
  • Comparison group comprised 1758 patients with anterior circulation infarction (ACI).
  • Data collected included demographics, time to admission, National Institute of Health Stroke Scale (NIHSS) scores, treatment received, and functional outcomes (modified Rankin Scale, Barthel Index).

Main Results:

  • PCI patients were younger (68.2 vs 71.8 years) and experienced longer median time from symptom onset to admission (3.8 vs 2.2 hours) compared to ACI patients.
  • Fewer PCI patients arrived within the 4.5-hour window for acute intervention (56.2% vs 72.5%).
  • PCI patients had lower baseline and day 7 NIHSS scores, lower modified Rankin Scale scores, and higher Barthel Index scores, indicating better functional outcomes, despite receiving intravenous thrombolysis less frequently (9.9% vs 21.5%).

Conclusions:

  • Posterior circulation infarction (PCI) patients tend to be younger and have better functional outcomes than those with anterior circulation infarction (ACI).
  • Despite similar diagnostic investigations, thrombolysis rates are significantly lower for PCI patients.
  • This study highlights the need for increased awareness and potentially tailored treatment strategies for PCI to improve acute intervention rates.