title: Intravenous thrombolysis in posterior cerebral artery infarctions.
abstract: BACKGROUND
  Approximately 5-10% of all acute ischemic strokes (AIS) occur in the territory of the posterior cerebral artery (PCA). Little is known about intravenous thrombolysis (IVT) in this infarct subgroup in terms of outcome and intracerebral hemorrhage rates. The aim of our study was to evaluate differences between supratentorial PCA infarcts and anterior circulation infarcts regarding baseline characteristics, stroke severity, outcome, safety and clinical findings, which would implicate a change in the existing thrombolysis practice in patients with PCA stroke.
  
  
  METHODS
  All patients with AIS in the supratentorial PCA territory receiving IVT between 01/2006 and 01/2010 were selected from the Erlangen Thrombolysis Database (group 1, n = 21). They were compared to all IVT patients with strokes in other supratentorial vascular territories over the same period of time (group 2, n = 398). Baseline demographic data, as well as clinical and laboratory findings were analyzed. The outcome was assessed using the modified Rankin Scale at 3 months.
  
  
  RESULTS
  Only serum glucose levels at baseline (110.5 ± 36.1 vs. 127.2 ± 48.2 mg/dl; p = 0.036) and the baseline National Institutes of Health Stroke Scale score (median 6.5 vs. 9; p = 0.016) were significantly lower in group 1 compared to group 2. Favorable clinical outcome (57.1 vs. 48.6%; p = 0.445) and intracerebral hemorrhage rates (4.8 vs. 4%; p = 1.000) were comparable in both groups.
  
  
  CONCLUSIONS
  No substantial differences were found between supratentorial PCA and anterior circulation infarcts. Our data on safety and efficacy support the present common thrombolysis practice in supratentorial PCA infarct patients, though an indication for IVT should rather be based on the existence of functionally disabling deficit than merely on the National Institutes of Health Stroke Scale.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany. lorenz.breuer@uk-erlangen.de
authors.forename: L
authors.initials: L
authors.lastname: Breuer
authors.forename: H B
authors.initials: HB
authors.lastname: Huttner
authors.forename: K
authors.initials: K
authors.lastname: Jentsch
authors.forename: C
authors.initials: C
authors.lastname: Blinzler
authors.forename: K
authors.initials: K
authors.lastname: Winder
authors.forename: T
authors.initials: T
authors.lastname: Engelhorn
authors.forename: M
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020762:Infarction, Posterior Cerebral Artery / Q000188:drug therapy* / Q000401:mortality; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D020521:Stroke / Q000188:drug therapy / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents