What are the eligibility criteria for tissue plasminogen activator (tPA) treatment of posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The eligibility criteria for treatment between 3 and 4.5 hours are similar to those employed for treatment prior to 3 hours, as established in the AHA/ASA's 2007 guidelines, [19] but with the exclusion criteria expanded to include any of the following patient characteristics:

  • Age older than 80 years

  • Use of oral anticoagulants

  • Baseline NIH Stroke Scale score of greater than 25

  • History of both minor stroke and diabetes

If a clear time of onset can be established, stroke in the PCA territory may be treated with IV TPA. However, because isolated PCA territory symptoms may be subtle or underappreciated, patients may mistake the time of stroke onset. Patients who experience significant motor, sensory, or language symptoms (middle cerebral artery [MCA] or basilar artery syndromes) are more likely to present urgently and with more precise time of onset. Administration of TPA beyond the recommended time limits likely offers no benefit to patients and exposes them to increased risk of intracerebral hemorrhage.


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