Abstract
The current time-based approach for patient selection for intravenous (IV) thrombolysis in an acute stroke setting neglects the individual variation of cerebral blood flow impairment. This approach restricts the eligible patient population. In the last decade, advanced imaging and especially MRI diffusion- and perfusion-weighted imaging (DWI–PWI) techniques have been used to select patients for IV thrombolysis outside the current 4.5 h time window. Most of these studies focus on the anterior (carotid artery) cerebral circulation only. We report the case of an acute ischemic stroke due to a dissection of the right vertebral artery and occlusion of the posterior inferior cerebellar artery with good clinical outcome. The patient received IV thrombolysis far beyond the current established time window. This decision was based upon a marked MRI DWI–PWI mismatch zone in the posterior circulation territory.
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Lansberg MG, O’Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE et al (2012) Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 1(2 Suppl):e601S–e636S
Yoo AJ, Pulli B, Gonzalez RG (2011) Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive review. Expert Rev Cardiovasc Ther 9(7):857–876
Rother J, Schellinger PD, Gass A, Siebler M, Villringer A, Fiebach JB et al (2002) Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 hours. Stroke 33(10):2438–2445
Warach S, Al-Rawi Y, Furlan AJ, Fiebach JB, Wintermark M, Lindsten A et al (2012) Refinement of the magnetic resonance diffusion-perfusion mismatch concept for thrombolytic patient selection: insights from the desmoteplase in acute stroke trials. Stroke 43(9):2313–2318
Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E et al (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 60(5):508–517
Jakubowska MM, Michels P, Muller-Jensen A, Leppien A, Eckert B (2008) Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset. Neuroradiology 50(7):599–604
Joux J, Nazarov B, Olindo S, Smadja D (2012) Very late IV thrombolysis in acute ischemic stroke: a successful case in proximal MCA occlusion. Clin Neurol Neurosur 114(6):820–822
Kohrmann M, Sauer R, Huttner HB, Engelhorn T, Doerfler A, Schellinger PD (2009) MRI mismatch-based intravenous thrombolysis for isolated cerebellar infarction. Stroke 40(5):1897–1899
Conflict of interest
The authors N. Deprez, V. De Herdt, J. Vandersteene, M. Acou, L. Defreyne, D. Hemelsoet declare that they have not conflict of interest.
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Deprez, N., De Herdt, V., Vandersteene, J. et al. Delayed intravenous thrombolysis based on MRI mismatch in posterior circulation stroke. Acta Neurol Belg 114, 113–115 (2014). https://doi.org/10.1007/s13760-013-0271-x
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DOI: https://doi.org/10.1007/s13760-013-0271-x