title: Outcomes of intravenous thrombolysis in posterior versus anterior circulation stroke.
abstract: OBJECTIVE
  Intravenous thrombolysis is an approved treatment for anterior (ACS) and posterior (PCS) circulation stroke. However, no randomized controlled trial has investigated safety and efficacy of intravenous thrombolysis according to stroke territory, although PCS is assumed to differ from ACS in many ways. We aimed to compare the safety and clinical outcome of intravenous thrombolysis applied to patients with PCS and ACS.
  
  
  METHODS
  Prospectively collected data of 883 consecutive patients with acute ischemic stroke (788 ACS, 95 PCS) treated with intravenous thrombolysis in 3 Swiss stroke centers were analyzed. Presenting characteristics, symptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin scale 0 or 1) at 3 months were compared between patients with PCS and ACS.
  
  
  RESULTS
  As compared with patients with ACS, those with PCS were younger (mean age, 63 versus 67 years, P=0.012) and had a lower mean baseline National Institutes of Health Stroke Scale score (9 versus 12, P<0.001). Patients with PCS less often had symptomatic intracranial hemorrhage (0% versus 5%, P=0.026) and had more often a favorable outcome (66% versus 47%, P<0.001). Mortality was similar in the 2 groups (PCS, 9%; ACS, 13%; P=0.243). After multivariable adjustment, PCS was an independent predictor of lower symptomatic intracranial hemorrhage frequency (P=0.001), whereas stroke territory was not associated either with favorable outcome (P=0.177) or with mortality (P=0.251).
  
  
  CONCLUSIONS
  Our study suggests that PCS is associated with a lower risk of symptomatic intracranial hemorrhage after intravenous thrombolysis as compared with ACS, whereas favorable outcome and mortality were similar in the 2 stroke territories.
authors.affiliation: Neurology Department, University Hospital of Zurich, 8091 Zurich, Switzerland. hakan.sarikaya@usz.ch
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarikaya
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.forename: Felix
authors.initials: F
authors.lastname: Fluri
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Oliver
authors.initials: O
authors.lastname: Findling
authors.forename: Pietro
authors.initials: P
authors.lastname: Ballinari
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Baumgartner
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D013557:Switzerland; D015912:Thrombolytic Therapy