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Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke



Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischaemic stroke (ACIS) and posterior circulation ischaemic stroke (PCIS). Our aim was to evaluate the predictors for a good clinical outcome and intracerebral haemorrhage (ICH) in patients undergoing posterior circulation IVT based on the initially performed CT or MR imaging.


The study cohort consisted of 1643 consecutive patients with acute ischaemic stroke (1440 ACIS, 203 PCIS cases) who underwent IVT. ICH was classified according to the European Cooperative Acute Stroke Study (ECASS) I protocol. Clinical outcome was assessed using the modified Rankin scale (mRS). Early ischaemic signs and pre-existing structural signs were assessed.


Good clinical outcomes (mRS 0–1) were noted in 45.3% of patients with PCIS, with a mortality rate of 14.8%. ICH was noted in 8.3%, and a large haemorrhage was found in 2.4% of patients. Some early ischaemic signs and pre-existing structural signs on initial CT/MR imaging correlated significantly with the 90-day clinical outcome.


Early ischaemic signs and pre-existing structural signs should be considered during the assessment of patients with PCIS eligible for IVT. Tissue hypoattenuation on initial CT scans correlates with an increased risk of death. Similarly to anterior circulation, atrophy on initial MRI may negatively predict good clinical outcome in posterior circulation.

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This study was conducted on an academic basis and was supported by AZV CR – Health Research Council of the Czech Republic no. 17-29452A, 17-30101A and NV19-06-00216; by grant project LO1304 from the Ministry of Education of the Czech Republic; by the institutional support of the Ministry of Health of the Czech Republic MH CZ – DRO (FNOL, 00098892) –2018,2019,2020. The journal’s rapid service fee was also funded by the above mentioned grants.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Medical Writing, Editorial, and Other Assistance

The authors thank Anne Johnson for language editing (Rightedit) which was supported by AZV CR – Health Research Council of the Czech Republic no. 17-29452A, 17-30101A and NV19-06-00216; by grant project LO1304 from the Ministry of Education of the Czech Republic; by the institutional support of the Ministry of Health of the Czech Republic MH CZ – DRO (FNOL, 00098892) –2018,2019,2020.


Tomáš Dorňák, Zuzana Sedláčková, Jakub Čivrný, Michal Král, Petra Divišová, Petr Polidar, Daniel Šaňák, Jana Zapletalová and Petr Kaňovský have nothing to disclose.

Compliance with Ethics Guidelines

The entire study was conducted in accordance with the Helsinki Declaration of 1975 (as revised in 2004 and 2008). All subjects gave informed consent with anonymised data processing. The study protocol was approved by institutional review board: ethic committee of Palacký University and University Hospital Olomouc.

Data Availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Tomáš Dorňák.

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Dorňák, T., Sedláčková, Z., Čivrný, J. et al. Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke. Adv Ther 38, 627–639 (2021).

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  • Alteplase
  • Imaging
  • Posterior circulation
  • Ischaemic stroke
  • Thrombolysis