Intravenous thrombolysis is more safe and effective for posterior circulation stroke: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China).
We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) with alteplase for anterior circulation stroke (ACS) and posterior circulation stroke (PCS). From a large multicenter prospective registry-the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database-all patients who received IVT within 4.5 hours after stroke onset was reviewed. According to the clinical presentations and imaging findings, the eligible patients were divided into ACS and PCS groups. The safety and efficacy outcome measures included post-IVT symptomatic intracranial hemorrhage (sICH), parenchymal hematoma, and all intracranial hemorrhage (aICH) within 7 days, mortality within 90 days, excellent recovery (modified Rankin Scale 0-1), and functional independence (modified Rankin Scale 0-2) at 90 days. For comparing the outcomes between both groups, the odds ratios (ORs) with 95% confidence intervals (CIs) and the adjusted ORs with 95% CIs were analyzed by univariate and multivariate logistic regression models. Of 953 patients enrolled, 829 patients had ACS and 124 had PCS. The patients with PCS had less often atrial fibrillation (11.3% vs 19.8%; P = 0.02), higher blood glucose level (8.31 vs 7.63 mmol/L; P = 0.02), and more white blood cell counts (8.79 vs 7.75 × 10/L; P = 0.001) than those with ACS. After adjustment for the potential confounders, multivariate logistic analysis showed that PCS patients had not only lower rates of sICH (3.2% vs 7.7%; OR 0.28, 95% CI 0.09-0.90), parenchymal hematoma (1.6% vs 9.2%; OR 0.13, 95% CI 0.03-0.57), and aICH (8.1% vs 20.4%; OR 0.26, 95% CI 0.12-0.54), but also higher proportions of excellent recovery (55.7% vs 41.6%; OR 2.27, 95% CI 1.42-3.61) and functional independence (63.9% vs 53.0%; OR 2.33, 95% CI 1.40-3.89) compared with ACS patients. However, there was no significant difference in the occurrence of mortality (OR 0.86, 95% CI 0.39-1.91) between both groups in the multivariate model, although more PCS patients seemed to die within 90 days than did ACS patients (15.6% vs 10.1%; OR 1.64, 95% CI 0.96-2.82) in the univariate analysis. Our study suggests that IVT with alteplase is more safe and effective for PCS.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei China National Clinical Research Center for Neurological Diseases Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University Center of Stroke, Beijing Institute for Brain Disorders Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Xu
X
Tong
Xiaoling
X
Liao
Yuesong
Y
Pan
Yibin
Y
Cao
Chunjuan
C
Wang
Liping
L
Liu
Huaguang
H
Zheng
Xingquan
X
Zhao
Chunxue
C
Wang
Yilong
Y
Wang
Yongjun
Y
Wang
D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002681:China / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents