Skip to main content
Dryad

Posterior Circulation Ischemia in the Endovascular Era

Data files

May 13, 2021 version files 15.58 KB

Abstract

Objective To elucidate the topic a literature review of clinical, radiographic and anatomical features of posterior circulation ischemia (PCI) was summarized, and systematic review of the literature on the management of basilar artery occlusion (BAO) and associated outcomes was performed.

Methods Review of literature was conducted to identify publications describing the risk factors, etiology, clinical presentation and imaging for PCI. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.1 Pubmed and Ovid MEDLINE were searched from 2009-2020 for papers relating to management of BAO.  A synthesis was compiled summarizing current evidence on management of BAO.

Results PCI account for 15-20% of strokes.  Risk factors are similar to anterior circulation strokes.  Dizziness (47%), unilateral limb weakness (41%), and dysarthria (31%) are most common presenting symptoms.  A non-contrast head CT will identify PCI in 21% of cases, diffusion weighted MRI or CT perfusion increase sensitivity to 85%.  Recent trials have shown endovascular therapy can achieve >80% recanalization of BAO.  In select patients, 30-60% that receive endovascular treatment can achieve favorable outcome versus without 13% achieve good outcome and 86% mortality rate.

Conclusion PCI can present with waxing-and-waning symptoms or clinical findings that overlap with stroke mimics and anterior circulation ischemia, making diagnosis more heavily dependent on imaging.  Recanalization is an important predictor of improved functional outcome and survival.  In this endovascular era, trials of BAO are fraught with deterrents to enrollment.  Despite limitations, endovascular treatment has shown improved outcome in select patients.