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Published on: November 26, 2013
Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke
Tomáš Dorňák1, Michal Král2, Zuzana Sedláčková3
1Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic. dornaktomas@seznam.cz.
Insights
Intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) in posterior circulation stroke (PCS) is predicted by atrial fibrillation, neurological deficit, low consciousness, and specific artery occlusions. Certain patient profiles may benefit from IVT despite borderline indications, with less impact from treatment time on outcomes.
Area of Science:
- Neurology
- Vascular Neurology
- Emergency Medicine
Background:
- Intravenous thrombolysis (IVT) is a cornerstone treatment for acute ischemic stroke (IS) affecting both anterior circulation stroke (ACS) and posterior circulation stroke (PCS).
- Knowledge regarding predictors of intracranial hemorrhage (ICH) following IVT in PCS is limited due to the lower incidence of PCS and ICH in this population.
Purpose of the Study:
- To identify significant predictors of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) in patients with posterior circulation stroke (PCS).
Main Methods:
- Retrospective analysis of 1281 consecutive IS patients treated with IVT, focusing on 158 patients with PCS.
- Data collected included baseline characteristics, stroke severity (NIHSS), consciousness level, arterial occlusion (basilar artery, PCA), and endovascular therapy.
- Logistic regression analysis was employed to determine significant predictors of ICH.
Main Results:
- Out of 158 PCS patients, 11 (7%) experienced ICH.
- Significant predictors for ICH included atrial fibrillation, higher National Institutes of Health Stroke Scale (NIHSS) score, decreased level of consciousness, basilar artery occlusion, posterior cerebral artery (PCA) occlusion, and additional endovascular therapy.
- Time to IVT did not appear to significantly influence ICH risk or favorable outcomes in PCS compared to ACS.
Conclusions:
- Atrial fibrillation, neurological deficit severity, reduced consciousness, and specific arterial occlusions are key predictors of ICH after IVT in PCS.
- Consideration of IVT in PCS patients with brainstem lesions, vertebral artery occlusion, or absence of basilar/PCA occlusion may be warranted, potentially without increased ICH risk.
- Treatment timing appears less critical for ICH risk and outcomes in PCS than in ACS.
Abstract:
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.
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