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Published on: November 26, 2013
Intravenous thrombolysis for ischemic stroke in the posterior circulation: A systematic review and meta-analysis
Robrecht R M M Knapen1, Senta Frol2, Sander M J van Kuijk3
1Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and CARIM, School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Insights
Intravenous thrombolysis (IVT) for posterior circulation strokes (PCS) shows favorable outcomes. Standard time window treatment significantly improves functional outcomes and reduces mortality compared to extended windows.
Area of Science:
- Neurology
- Cardiovascular Diseases
Background:
- Posterior circulation strokes (PCS) often lead to poor neurological outcomes without treatment.
- Intravenous thrombolysis (IVT) is a recommended treatment for ischemic stroke in both anterior and posterior circulations.
Approach:
- A systematic review and meta-analysis of 12 studies (1589 patients) evaluated IVT outcomes in PCS.
- Data were analyzed using weighted averages, with subgroup analyses for standard (<4.5 hours) and extended (>4.5 hours) time windows.
Key Points:
- IVT in PCS resulted in a 63% favorable functional outcome, 19% mortality, and 4% symptomatic intracranial hemorrhage (sICH).
- Treatment within the standard time window yielded significantly higher favorable outcomes (77%) and lower mortality and sICH rates compared to the extended window.
Conclusions:
- IVT is a safe and effective treatment for PCS across both standard and extended time windows.
- The efficacy of IVT for PCS is notably higher when administered within the standard time window.
Objectives:
Intravenous thrombolysis (IVT) is recommended in patients with ischemic stroke in the anterior and posterior circulation. Neurological outcomes due to posterior circulation strokes (PCS) without treatment remain poor. Our aim was to overview the literature on outcomes of IVT and conservative treatment in PCS, based on a systematic review and meta-analysis.
Methods:
A systematic literature search was performed on February 27th 2023. Outcome measures included favorable functional outcome at 90 days (modified Rankin Scale [mRS] 0-2), mortality at 90 days, and symptomatic intracranial hemorrhages (sICH). Weighted averages with DerSimonian-Laird approach was used to analyze the data. Subgroup analyses by time window were performed: standard time window (<4.5 hours after symptom onset) and extended time window (>4.5 hours). Analyses were performed using R.
Results:
Eight prospective and four retrospective cohort studies were included (n = 1589 patients); no studies with conservative treatment were eligible. The pooled weighted probability regarding favorable functional outcome after IVT was 63 % (95 %CI:0.45-0.78), for mortality 19 % (95 %CI:0.11-0.30), and for sICH 4 % (95 %CI:0.02-0.07). Subgroup analyses showed higher probabilities on achieving favorable functional outcomes for patients treated in the standard (77 %; 95 %CI:0.62-0.88) compared to the extended time window (38 %; 95 %CI:0.29-0.48) with RR = 1.93 (95 %CI:1.66-2.24). Lower probabilities regarding mortality at 90 days and sICH were seen in patients treated in standard compared to extended time window (RR = 0.42, 95 %CI:0.34-0.51 and RR = 0.27, 95 %CI:0.16-0.45, respectively).
Conclusions:
IVT in patients with PCS seems to be safe and effective in standard and extended time window. The effect of IVT is higher in the standard time window.
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