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dc.contributor.authorMarkus, Hugh S
dc.contributor.authorMichel, Patrik
dc.date.accessioned2022-08-06T18:00:23Z
dc.date.available2022-08-06T18:00:23Z
dc.date.issued2022-08
dc.identifier.issn1747-4930
dc.identifier.other10.1177_17474930221107500
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/339911
dc.description.abstractOne-fifth of strokes occur in the territory of the posterior circulation, but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, has received much less attention than similar interventions for the anterior circulation. In this review, we overview the treatment of posterior circulation stroke, including both interventions in the acute setting and secondary prevention. We focus on areas in which the management of posterior circulation stroke differs from that of stroke in general and highlight recent advances.Effectiveness of acute revascularization of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower hemorrhage risks than in the anterior circulation. The recent ATTENTION and BAOCHE trials have demonstrated that thrombectomy benefits strokes with basilar artery occlusion, but its effect on other posterior occlusion sites remains uncertain. Ischemic and hemorrhagic space-occupying cerebellar strokes can benefit from decompressive craniectomy.Secondary prevention of posterior circulation strokes includes aggressive treatment of cerebrovascular risk factors with both drugs and lifestyle interventions and short-term dual anti-platelet therapy. Randomized controlled trial (RCT) data suggest basilar artery stenosis is better treated with medical therapy than stenting, which has a high peri-procedural risk. Limited data from RCTs in stenting for vertebral stenosis suggest that intracranial stenosis is currently best treated with medical therapy alone; the situation for extracranial stenosis is less clear where stenting for symptomatic stenosis is an option, particularly for recurrent symptoms; larger RCTs are required in this area.
dc.languageen
dc.publisherSAGE Publications
dc.subjectReviews
dc.subjectVertebral
dc.subjectbasilar
dc.subjectposterior circulation
dc.subjectvertebrobasilar
dc.subjectstenting
dc.subjectacute stroke therapy
dc.subjecttreatment
dc.subjectprevention
dc.titleTreatment of posterior circulation stroke: Acute management and secondary prevention.
dc.typeArticle
dc.date.updated2022-08-06T18:00:23Z
prism.endingPage732
prism.issueIdentifier7
prism.publicationNameInt J Stroke
prism.startingPage723
prism.volume17
dc.identifier.doi10.17863/CAM.87334
rioxxterms.versionofrecord10.1177/17474930221107500
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.licenseref.startdate2022-06-28
dc.contributor.orcidMarkus, Hugh S [0000-0002-9794-5996]
dc.contributor.orcidMichel, Patrik [0000-0003-4954-7579]
dc.identifier.eissn1747-4949
pubs.funder-project-idBritish Heart Foundation (RE/18/1/34212)
pubs.funder-project-idNational Institute for Health Research (IS-BRC-1215-20014)
cam.issuedOnline2022-06-28
rioxxterms.freetoread.startdate2022-06-28
rioxxterms.freetoread.startdate2022-06-28


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