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RT Journal Article
SR Electronic
T1 MR Imaging-Guided Intravenous Thrombolysis in Posterior Cerebral Artery Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 419
OP 421
DO 10.3174/ajnr.A2300
VO 32
IS 2
A1 Förster, A.
A1 Gass, A.
A1 Kern, R.
A1 Wolf, M.E.
A1 Hennerici, M.G.
A1 Szabo, K.
YR 2011
UL http://www.ajnr.org/content/32/2/419.abstract
AB SUMMARY: PCA stroke was under-represented in or excluded from the clinical trials examining thrombolysis based on the PWI-DWI mismatch concept. We present 6 patients with PCA stroke treated with thrombolysis in an extended time window by using MR imaging criteria. Symptoms included aphasia, sensorimotor hemiparesis, hemineglect, and homonymous hemianopia. Initial MR imaging demonstrated circumscribed ischemic lesions in the thalamus or hippocampus; MR angiography showed PCA occlusion with corresponding hypoperfusion. Follow-up MR imaging showed partial/complete recanalization in 4 patients with minor infarction growth, while in 1 patient, PCA occlusion persisted, resulting in a large PCA infarction. Three patients improved within 2 hours; at discharge, homonymous hemianopia had resolved in 3 patients. At 3-month follow-up, 4 patients had an mRS score of 0 or 1. These results support the approach to treat patients with PCA stroke with thrombolysis based on the mismatch concept. Because rehabilitation options for hemianopia are limited, thrombolysis may enhance the chance of a favorable outcome. A-S-C-OA for atherosclerosis, S for small vessel disease, C for cardiac source, O for other causeDWIdiffusion-weighted imagingFLAIRfluid-attenuated inversion recoveryMRAMR angiographymRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke ScaleOTTonset to treatment timePCAposterior cerebral arteryPWIperfusion-weighted imagingrtPArecombinant tissue plasminogen activatorTTPtime to peak