title: Posterior vs. anterior circulation infarction: demography, outcomes, and frequency of hemorrhage after thrombolysis.
abstract: BACKGROUND
  Intravenous thrombolysis is considered to be the standard specific reperfusion therapy in acute ischemic stroke in both anterior and posterior cerebral circulation.
  
  
  OBJECTIVE
  Our aim was to evaluate the 90-day outcome and rate of intracranial hemorrhage after recombinant tissue plasminogen activator administration in posterior circulation stroke and to compare the intracranial hemorrhage risk for posterior circulation stroke and anterior circulation stroke.
  
  
  METHODS
  The set consisted of 877 consecutive acute ischemic stroke patients (777 anterior circulation stroke; 100 posterior circulation stroke) who underwent intravenous thrombolysis with recombinant tissue plasminogen activator in a standard dose of 0·9 mg/kg. The role of following factors was assessed: presenting characteristics, intracranial hemorrhage classification according to ECASS I, mortality, and 90-day clinical outcome assessed using the modified Rankin scale.
  
  
  RESULTS
  Good clinical outcomes (modified Rankin scale 0-2) were noted in 59% of posterior circulation stroke patients, with a mortality rate of 19%. Intracerebral hemorrhage was significantly less frequent in posterior circulation stroke than in anterior circulation stroke patients (5·1 vs. 17·2%; P = 0·002). The risk of large hemorrhage (parenchymal hematoma 1 and 2) was 5·2 times higher in anterior circulation stroke patients (P = 0·007). The following additional statistically significant differences were found between posterior circulation stroke and anterior circulation stroke patients: median age, male gender, presence of atrial fibrillation, hyperlipidemia, median time to treatment, and median blood glucose level on admission.
  
  
  CONCLUSIONS
  Our study suggests that posterior circulation stroke is associated with a lower risk of intracranial hemorrhage than anterior circulation stroke is.
authors: Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Tomáš
authors: T
authors: Dorňák
authors: Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Michal
authors: M
authors: Král
authors: Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Martin
authors: M
authors: Hazlinger
authors: Department of Neurology, Palacký University, Olomouc, Czech Republic.
authors: Roman
authors: R
authors: Herzig
authors: Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Tomáš
authors: T
authors: Veverka
authors: Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Stanislav
authors: S
authors: Buřval
authors: Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Daniel
authors: D
authors: Šaňák
authors: Department of Medical Biophysics, Palacký University, Olomouc, Czech Republic.
authors: Jana
authors: J
authors: Zapletalová
authors: Department of Radiology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Kristýna
authors: K
authors: Antalíková
authors: Department of Neurology, Comprehensive Stroke Center, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
authors: Petr
authors: P
authors: Kaňovský
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D002560:Cerebrovascular Circulation; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: anterior circulation; intracranial hemorrhage; intravenous thrombolysis; ischemic stroke; posterior circulation