Intravenous Thrombolysis in Posterior Circulation Stroke

Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset. Introduction History of Intravenous Thrombolysis—The Most Relevant Studies Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS). Recombinant tissue plasminogen activator (rtPA, alteplase) was licensed for the first time in 1996 in North America for intravenous use within 3 h. A restricted conditional license for the use of rtPA within 3 h was granted in Europe in 2002. At the beginning of the rtPA era (1992/1993), three smallplacebo-controlled studies reported its efficacy in the early stages of ischemic stroke (1–3). Later, three much largerplacebo-controlled trials showed the benefits of intravenous rtPA given to patients with ischemic stroke selected by clinical symptoms and CT. Studies by the National Institute of Neurological Disorders and Stroke (NINDS) and Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemi...
Source: Frontiers in Neurology - Category: Neurology Source Type: research