Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke

作者：Boris Keselman, Zuzana Gdovinová, Dalius Jatužis, Teresa Pinho e Melo, Aleksandras Vilionskis, Roberto Cavallo, Senta Frol, Lubomír Jurák, Bahar Aksay Koyuncu, Ana Paiva Nunes, Alfredo Petrone, Kennedy R. Lees, Michael V. Mazya · 发表于：Stroke · 年份：2020 · DOI：10.1161/strokeaha.119.027071 · 被引用次数：94 · 研究领域：Acute Ischemic Stroke Management、Venous Thromboembolism Diagnosis and Management、Intracerebral and Subarachnoid Hemorrhage Research

Background and Purpose— Posterior circulation stroke (PCS) accounts for 5% to 19% of patients with acute stroke receiving intravenous thrombolysis. We aimed to compare safety and outcomes following intravenous thrombolysis between patients with PCS and anterior circulation stroke (ACS) and incorporate the results in a meta-analysis. Methods— We included patients in the Safe Implementation of Treatments in Stroke Thrombolysis Registry 2013 to 2017 with computed tomography/magnetic resonance angiographic occlusion data. Outcomes were parenchymal hematoma, symptomatic intracerebral hemorrhage (SICH) per SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study), ECASS II (Second European Co-operative Stroke Study) and NINDS (Neurological Disorders and Stroke definition), 3-month modified Rankin Scale score, and death. Adjustment for SICH risk factors (age, sex, National Institutes of Health Stroke Scale, blood pressure, glucose, and atrial fibrillation) and center was done using inverse probability treatment weighting, after which an average treatment effect (ATE) was calculated. Meta-analysis of 13 studies comparing outcomes in PCS versus ACS after intravenous thrombolysis was conducted. Results— Of 5146 patients, 753 had PCS (14.6%). Patients with PCS had lower median National Institutes of Health Stroke Scale: 7 (interquartile range, 4–13) versus 13 (7–18), P <0.001 and fewer cerebrovascular risk factors. In patients with PCS versus ACS, parenchymal hematoma o...