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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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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
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.
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.
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