My takeaway from this, don't have a posterior circulation stroke, interventions are unproven and uncertain. Unless you want to be a guinea pig in unregulated research by your doctor. With a great stroke association we would have a strategy in place to do research to solve this problem. But NO, we have fucking failures of stroke associations doing nothing to solve stroke.
Treatment of posterior circulation stroke: acute management and secondary prevention
Abstract
One fifth of strokes occur in the territory of the posterior circulation but their management, particularly acute reperfusion therapy and neurointervention procedures for secondary prevention, have received much less attention than similar interventions for the anterior circulation. In this review we overview treatment of posterior circulation stroke, including both interventions in the acute setting and, secondary prevention. We focus on areas in which management of posterior circulation stroke differs from that of stroke in general, and highlight recent advances.
Effectiveness of acute revascularisation of posterior circulation strokes remains in large parts unproven. Thrombolysis seems to have similar benefits and lower haemorrhage 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. Ischaemic and haemorrhagic 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 antiplatelet therapy. Randomised 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 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.
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