Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.

Comprehensive Stroke Center Department of Neurology Palacký University and University Hospital Olomouc 1 P Pavlova 6 CZ 775 20 Olomouc Czech Republic

Comprehensive Stroke Center Department of Radiology Palacký University and University Hospital Olomouc Olomouc Czech Republic

Department of Medical Biophysics Palacký University Olomouc Czech Republic

Transl Stroke Res. 2018 Dec;9(6):589. doi: 10.1007/s12975-018-0618-y. PubMed

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Arch Neurol. 2012 Mar;69(3):346-51 PubMed

Cerebrovasc Dis. 2010;29(6):597-604 PubMed

Medicine (Baltimore). 2016 Jun;95(24):e3848 PubMed

Neurology. 2004 May 25;62(10):1854-6 PubMed

Eur J Neurol. 2006 Jul;13(7):742-8 PubMed

BMJ. 1998 Apr 18;316(7139):1236-8 PubMed

J Neurol Sci. 2013 Dec 15;335(1-2):96-100 PubMed

Neurology. 1993 Aug;43(8):1528-33 PubMed

J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2543-8 PubMed

Stroke. 2012 Nov;43(11):3003-6 PubMed

J Neurol. 2010 Jun;257(6):999-1003 PubMed

Neurocrit Care. 2016 Apr;24(2):172-9 PubMed

Neurology. 2004 Feb 24;62(4):574-80 PubMed

Stroke. 2012 Jan;43(1):240-2 PubMed

Neurology. 2008 Jun 10;70(24 Pt 2):2371-7 PubMed

Int J Stroke. 2015 Dec;10(8):1224-8 PubMed

Stroke. 2013 Jun;44(6):1561-6 PubMed

Stroke. 2011 Sep;42(9):2498-502 PubMed

JAMA. 1995 Oct 4;274(13):1017-25 PubMed

Stroke. 2009 Jan;40(1):140-6 PubMed

Neurocrit Care. 2015 Dec;23(3):394-400 PubMed

Cerebrovasc Dis. 2011;32(4):349-53 PubMed

Stroke. 2008 Dec;39(12):3316-22 PubMed

Front Neurol Neurosci. 2012;30:128-31 PubMed

Ann Neurol. 2013 Jun;73(6):688-94 PubMed

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Dec;158(4):528-34 PubMed

Cerebrovasc Dis. 2008;25(5):457-507 PubMed

Am J Epidemiol. 2007 Mar 15;165(6):710-8 PubMed

Arch Neurol. 2005 Jul;62(7):1126-9 PubMed

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