Outcome after thrombolysis for acute isolated posterior cerebral artery occlusion.

BACKGROUND

To date, there is limited data on intra-arterial thrombolysis (IAT) and intravenous thrombolysis (IVT) for isolated posterior cerebral artery (PCA) occlusion. We aimed to evaluate recanalization, outcome and quality of life in patients who undergo thrombolysis for isolated PCA occlusion.

METHODS

Analysis of 9 patients treated with IAT and 9 patients treated with IVT with short-term (3 months) outcome and long-term (median 23 months) outcome after IAT.

RESULTS

9 of 546 patients treated with IAT (4 women and 5 men; median age 66 years) had isolated PCA occlusion. Median baseline National Institute of Health Stroke Scale (NIHSS) score on admission was 9. Eight patients presented with visual field defects and variable additional symptoms. One patient suffered bithalamic infarction. Median time to treatment was 5.8 h. Recanalization was complete in 2, partial in 2, minimal in 2, and not achieved in 3 patients. Recanalization tended to be better when the microcatheter was placed in or close to the thrombus. We observed no major complications, and 3 months outcome was favorable (modified Rankin Scale score 0-2) in 67% of the patients after IAT. During the same period, 9 patients with PCA occlusion were treated with IVT with 89% favorable clinical outcomes at 3 months. At long-term follow-up after IAT, neuropsychological domains were more severely impaired than other neurologic functions.

CONCLUSION

IAT is a feasible treatment of isolated PCA strokes. Clinical outcome was favorable in the majority of patients after IAT and IVT. No major complications were observed. Further studies are needed to compare IAT and IVT for isolated PCA stroke.