The safety and efficacy of intravenous thrombolysis (IVT) are well established in anterior circulation stroke (ACS) but are much less clear for posterior circulation stroke (PCS). The aim of this study was to evaluate the occurrence of parenchymal hematoma (PH) and 3-month clinical outcomes after IVT in PCS and ACS. In an observational, cohort multicenter study, we analyzed data from ischemic stroke patients treated with IVT prospectively collected in the SITS (Safe Implementation of Treatments in Stroke) registry in the Czech Republic between 2004 and 2018. Out of 10,211 patients, 1166 (11.4%) had PCS, and 9045 (88.6%) ACS. PH was less frequent in PCS versus ACS patients: 3.6 vs. 5.9%, odds ratio (OR) = 0.594 in the whole set, 4.4 vs. 7.8%, OR = 0.543 in those with large vessel occlusion (LVO), and 2.2 vs. 4.7%, OR = 0.463 in those without LVO. At 3 months, PCS patients compared with ACS patients achieved more frequently excellent clinical outcomes (modified Rankin scale [mRS] 0-1: 55.5 vs. 47.6%, OR = 1.371 in the whole set and 49.2 vs. 37.6%, OR = 1.307 in those with LVO), good clinical outcomes (mRS 0-2: 69.9 vs. 62.8%, OR = 1.377 in the whole set and 64.5 vs. 50.5%, OR = 1.279 in those with LVO), and had lower mortality (12.4 vs. 16.6%, OR = 0.716 in the whole set and 18.4 vs. 25.5%, OR = 0.723 in those with LVO) (p < 0.05 in all cases). In PCS versus ACS patients, an extensive analysis showed a lower risk of PH both in patients with and without LVO, more frequent excellent and good clinical outcomes, and lower mortality 3 months after IVT in patients with LVO.

Department of Clinical Neurosciences Faculty of Medicine University of Ostrava 708 00 Ostrava Czech Republic

Department of Neurology Comprehensive Stroke Center Charles University 2nd Faculty of Medicine Motol University Hospital 150 06 Prague Czech Republic

Department of Neurology Comprehensive Stroke Center Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc 779 00 Olomouc Czech Republic

Department of Neurology Comprehensive Stroke Center Faculty of Medicine University of Ostrava and University Hospital Ostrava 708 52 Ostrava Czech Republic

Department of Neurology Comprehensive Stroke Center Hospital České Budějovice 370 01 České Budějovice Czech Republic

Department of Neurology Comprehensive Stroke Center University Hospital Hradec Králové 500 05 Hradec Králové Czech Republic

Department of Neurology Comprehensive Stroke Center University Hospital in Pilsen and Faculty of Medicine in Pilsen Charles University 323 00 Pilsen Czech Republic

Department of Neurology Faculty of Health Studies Pardubice University and Pardubice Hospital 532 10 Pardubice Czech Republic

Department of Neurology Faculty of Medicine in Hradec Králové Charles University 500 03 Hradec Králové Czech Republic

International Clinical Research Center St Anne's University Hospital in Brno 602 00 Brno Czech Republic

Neurocenter Regional Hospital Liberec 460 63 Liberec Czech Republic

Research and Training Institute Agel Stroke Center Department of Neurology Hospital Ostrava Vítkovice 703 00 Ostrava Czech Republic

Research Institute for Biomedical Science 500 02 Hradec Králové Czech Republic

Stroke Center Department of Neurology City Hospital Ostrava 703 00 Ostrava Czech Republic

Stroke Center Department of Neurology Krnov Hospital 794 01 Krnov Czech Republic

Stroke Center Department of Neurology Thomayer University Hospital 140 59 Prague Czech Republic

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