Alteplase for Posterior Circulation Ischemic Stroke in a Later Timeframe

For stroke caused by anterior large-vessel occlusion, some data support extending the intravenous thrombolysis treatment window up to 24 hours after onset in patients with salvageable tissue selected using perfusion imaging. By contrast, in posterior-circulation stroke, perfusion studies are difficult because the lesions can be small, and artifacts are more frequent. However, the brainstem and cerebellum may be more resistant to ischemia and less likely to bleed than anterior-circulation structures. Given these differences, can we extend the thrombolysis window in these patients without perfusion imaging? To find out, the randomized, open-label EXPECTS trial enrolled 234 adults with acute posterior-circulation ischemic stroke presenting bet…