Intravenous thrombolysis for ischemic stroke in the posterior circulation: A systematic review and meta-analysis

Robrecht R M M Knapen*, Senta Frol, Sander M J van Kuijk, Janja Pretnar Oblak, Christiaan van der Leij, Robert J van Oostenbrugge, Wim H van Zwam

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

OBJECTIVES: Intravenous thrombolysis (IVT) is recommended in patients with ischemic stroke in the anterior and posterior circulation. Neurological outcomes due to posterior circulation strokes (PCS) without treatment remain poor. Our aim was to overview the literature on outcomes of IVT and conservative treatment in PCS, based on a systematic review and meta-analysis. METHODS: A systematic literature search was performed on February 27 2023. Outcome measures included favorable functional outcome at 90 days (modified Rankin Scale [mRS] 0-2), mortality at 90 days, and symptomatic intracranial hemorrhages (sICH). Weighted averages with DerSimonian-Laird approach was used to analyze the data. Subgroup analyses by time window were performed: standard time window (<4.5 hours after symptom onset) and extended time window (>4.5 hours). Analyses were performed using R. RESULTS: Eight prospective and four retrospective cohort studies were included (n=1589 patients); no studies with conservative treatment were eligible. The pooled weighted probability regarding favorable functional outcome after IVT was 63% (95%CI:0.45-0.78), for mortality 19% (95%CI:0.11-0.30), and for sICH 4% (95%CI:0.02-0.07). Subgroup analyses showed higher probabilities on achieving favorable functional outcomes for patients treated in the standard (77%; 95%CI:0.62-0.88) compared to the extended time window (38%; 95%CI:0.29-0.48) with RR=1.93 (95%CI:1.66-2.24). Lower probabilities regarding mortality at 90 days and sICH were seen in patients treated in standard compared to extended time window (RR=0.42, 95%CI:0.34-0.51 and RR=0.27, 95%CI:0.16-0.45, respectively). CONCLUSIONS: IVT in patients with PCS seems to be safe and effective in standard and extended time window. The effect of IVT is higher in the standard time window.
Original languageEnglish
Article number107641
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume33
Issue number5
Early online date21 Feb 2024
DOIs
Publication statusPublished - May 2024

Keywords

  • Acute ischemic stroke – Posterior circulation – Meta-analysis – Basilar artery occlusion (BAO) – Intravenous thrombolysis (IVT) – Posterior circulation strokes (PCS)

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