Posterior circulation ischaemic stroke diagnosis and management

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• The posterior circulation is crucial for brain function, and strokes in this territory present unique diagnostic and management challenges.
• Distinguishing posterior circulation stroke (PCS) from its mimics is essential for timely and appropriate treatment.
• Advances in neuroimaging and endovascular techniques are transforming the management of PCS.

Purpose of the Study:

• To provide a comprehensive overview of posterior circulation anatomy and PCS syndromes.
• To outline current best practices for hyperacute management and patient selection for intervention.
• To review the latest evidence on treatment options, including endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT).

Main Methods:

• Narrative review of existing literature, including observational studies and randomized clinical trials.
• Analysis of clinical features for diagnosing PCS and differentiating from stroke mimics.
• Evaluation of imaging findings to guide patient selection for interventions like EVT.

Main Results:

• Recent studies provide strong support for the efficacy of EVT in PCS, despite previous equivocal data.
• Advances in imaging facilitate better patient selection for thrombectomy in posterior circulation stroke.
• A heightened clinical suspicion for PCS is recommended to ensure prompt, evidence-based management.

Conclusions:

• Timely diagnosis and evidence-based management, including EVT and IVT, are critical for improving outcomes in PCS.
• Advanced imaging plays a vital role in optimizing patient selection for endovascular therapy.
• Clinicians must maintain a high index of suspicion for posterior circulation events to ensure prompt intervention.