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This narrative review provides an overview of the posterior circulation and the clinical features of common posterior circulation stroke (PCS) syndromes in the posterior arterial territories and how to distinguish them from mimics. We outline the hyperacute management of patients with suspected PCS with emphasis on how to identify those who are likely to benefit from intervention based on imaging findings. Finally, we review advances in treatment options, including developments in endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT), and the principles of medical management and indications for neurosurgery. Observational and randomised clinical trial data have been equivocal regarding EVT in PCS, but more recent studies strongly support its efficacy. There have been concomitant advances in imaging of posterior stroke to guide optimal patient selection for thrombectomy. Recent evidence suggests that clinicians should have a heightened suspicion of posterior circulation events with the resultant implementation of timely, evidence-based management.

Original publication

DOI

10.7861/clinmed.2022-0499

Type

Journal article

Journal

Clin Med (Lond)

Publication Date

05/2023

Volume

23

Pages

219 - 227

Keywords

basilar artery occlusion, endovascular thrombectomy, posterior circulation, posterior stroke, stroke, thrombolysis, Humans, Stroke, Brain Ischemia, Endovascular Procedures, Thrombectomy, Ischemic Stroke, Treatment Outcome, Thrombolytic Therapy