Comparison of safety and efficacy outcomes of intravenous thrombolysis in posterior vs. anterior circulation stroke

Abstract

Background & Objectives: Most previous large clinical studies of intravenous thrombolysis (IVT) focused on anterior circulation stroke (ACS). However, the results from ACS studies cannot fully represent posterior circulation stroke (PCS) patients due to their differences in symptoms, signs and etiologies. This study aimed to compare whether there are differences in thrombolysis outcomes between ACS and PCS patients who underwent IVT alone, and to explore predictors of outcomes in PCS after IVT.

Methods: We included acute ischemic stroke (AIS) patients who underwent IVT and divided them into ACS and PCS groups according to clinical symptoms and neuroimaging examinations. A series of baseline data were collected while symptomatic intracranial hemorrhage (sICH), hemorrhagic cerebral infarction (HI), parenchymal hemorrhage (PH), all intracranial hemorrhage (aICH), mortality and the modified Rankin Scale (mRS) score were employed to assess thrombolysis outcomes.

Results: Among 321 IVT-treated AIS patients, 87 had PCS. The incidence of sICH (1.1% vs. 9.8%, p=0.007), PH (1.1% vs. 9.8%, p=0.007), and aICH (4.6% vs. 15.8%, p=0.008) were lower in PCS than in ACS. A higher proportion of PCS achieved an excellent recovery (56.3% vs. 43.6%, p=0.042) and functional independence (66.7% vs. 53.8%, p=0.039) at 3 months poststroke. Logistic regression analysis identified the National Institutes of Health Stroke Scale (NIHSS) score (p<0.001) and pre-event antiplatelet therapy (p=0.005) as significant predictors of excellent recovery and the NIHSS score (p<0.001) as a unique predictor of functional independence at 90 days in PCS.

Conclusions: PCS patients had a lower risk of intracranial hemorrhage complications and better functional outcomes after IVT alone.