title: Less thrombolysis in posterior circulation infarction-a necessary evil?
abstract: OBJECTIVE
  Patients with posterior circulation infarction (PCI) have more subtle symptoms than anterior circulation infarction (ACI) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry.
  
  
  METHODS
  All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006-2013 were included (n=686). Patients with ACI (n=1758) were used for comparison.
  
  
  RESULTS
  Patients with PCI were younger (68.2 vs 71.8, P<.001), had longer median time from symptom onset to admission (3.8 hours vs 2.2 hours, P<.001), and were less likely to arrive at hospital within 4.5 hours from symptom onset (56.2% vs 72.5%, P<.001, ictus known). Patients with PCI scored lower on baseline National Institute of Health Stroke Scale (NIHSS) total score (3.2 vs 6.3, P<.001), and lower or equally on all items of NIHSS, except for ataxia in two limbs. Patients with PCI were less likely to receive i.v. thrombolytic treatment (9.9% vs 21.5%, OR 0.66, CI 0.47-0.94). On day 7, patients with PCI scored lower on NIHSS (2.8 vs 4.9, P<.001), modified Rankin Scale (2.0 vs 2.3, P<.001), and higher on Barthel Index (84.5 vs 76.0, P<.001).
  
  
  CONCLUSIONS
  Our study is, to our knowledge, the largest series reporting comprehensively on PCI verified by diffusion-weighted imaging. PCI patients are younger than ACI and have better outcome. PCI and ACI are equally investigated in the acute setting, but thrombolysis rates remain 50% lower in PCI.
authors.affiliation: Department of Neurology, Institute for Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: K M
authors.initials: KM
authors.lastname: Sand
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Naess
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
authors.forename: R M
authors.initials: RM
authors.lastname: Nilsen
authors.affiliation: Department of Neurology, Institute for Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Thomassen
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: J M
authors.initials: JM
authors.lastname: Hoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: cerebrovascular diseases; critical care; stroke; treatment