The effects of pharmaceutical thrombolysis and multi-modal therapy on patients with acute posterior circulation ischemic stroke: Results of a one center retrospective study

BACKGROUND: The treatment method for acute ischemic stroke is rapidly developing, and the effects of endovascular modalities, when used alone or in combination, needs to be studied. We aimed to identify the difference between pharmaceutical thrombolysis and multi-modal therapy (MMT) used in acute posterior circulation ischemic stroke (APCIS) patients and also to detect the predictors for successful recanalization and favorable outcomes. METHODS: A retrospective analysis of patients with APCIS who received thrombolytic pharmaceuticals and MMT from 2011 to 2016 was performed at the stroke center. Demographic information, therapeutic methods and the results were recorded. Logistic regression model was constructed in variables to determine the predictors of outcome. RESULTS: A total of 124 patients were included in this study, the mean age was 59.6 ± 9.5 years and the mean admission National Institutes of Health Stroke Scale (NIHSS) was 15.1 ± 6.6. Recanalization was achieved in 87 (70.2%) patients and favorable outcomes were observed in 65 (52.4%) patients. Patients treated with MMT demonstrated a higher recanalization rate, especially the use of stent placement and thrombectomy device, which were also related to the favorable outcome three months post-stroke. Logistic regression showed that stent placement and thrombectomy were the predictors of recanalization, and a favorable outcome was associated with coronary artery disease, MMT methods as well as recanalization. CONCLUSION: MMT methods, especially stent placement and thrombectomy device may be the first recommended for patients with a delayed admission time, and it may have the advantage of better perfusion and neurological outcomes.