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Less thrombolysis in posterior circulation infarction—a necessary evil?
Author(s) -
Sand K. M.,
Næss H.,
Nilsen R. M.,
Thomassen L.,
Hoff J. M.
Publication year - 2017
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12627
Subject(s) - conventional pci , medicine , thrombolysis , modified rankin scale , stroke (engine) , infarction , cardiology , barthel index , neurology , myocardial infarction , physical therapy , ischemic stroke , ischemia , activities of daily living , mechanical engineering , psychiatry , engineering
Objectives Patients with posterior circulation infarction ( PCI ) have more subtle symptoms than anterior circulation infarction ( ACI ) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry. Methods All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006–2013 were included (n=686). Patients with ACI (n=1758) were used for comparison. Results Patients with PCI were younger (68.2 vs 71.8, P <.001), had longer median time from symptom onset to admission (3.8 hours vs 2.2 hours, P <.001), and were less likely to arrive at hospital within 4.5 hours from symptom onset (56.2% vs 72.5%, P <.001, ictus known). Patients with PCI scored lower on baseline National Institute of Health Stroke Scale ( NIHSS ) total score (3.2 vs 6.3, P <.001), and lower or equally on all items of NIHSS , except for ataxia in two limbs. Patients with PCI were less likely to receive i.v. thrombolytic treatment (9.9% vs 21.5%, OR 0.66, CI 0.47–0.94). On day 7, patients with PCI scored lower on NIHSS (2.8 vs 4.9, P <.001), modified Rankin Scale (2.0 vs 2.3, P <.001), and higher on Barthel Index (84.5 vs 76.0, P <.001). Conclusions Our study is, to our knowledge, the largest series reporting comprehensively on PCI verified by diffusion‐weighted imaging. PCI patients are younger than ACI and have better outcome. PCI and ACI are equally investigated in the acute setting, but thrombolysis rates remain 50% lower in PCI .