Medicine (RMH) - Theses

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Author: Alemseged, Fana × End date: 2023 × Start date: 2020 × Type: PhD thesis ×

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    Treatment and prognosis in posterior circulation ischaemic stroke
    Alemseged, Fana ( 2021)
    Acute ischemic stroke is caused by a blocked blood vessel in the cerebral circulation. It is the most common form of stroke worldwide and a major cause of disability and death. One in five ischaemic strokes affects the posterior circulation. This type of stroke is associated with high risk of recurrence, disability and mortality. Diagnosing posterior circulation stroke can be challenging, as it often presents with non-specific or fluctuating symptoms. Several aspects of posterior circulation stroke are poorly understood compared to anterior circulation stroke. Treatments to reopen the blocked blood vessel and reperfuse the brain are available but patients with posterior circulation stroke were excluded from most of the randomized controlled trials which showed the benefit of reperfusion therapies in ischaemic stroke. This thesis examines the natural history, clinical and neuroimaging prognostic factors of outcome and treatment response in patients with posterior circulation stroke. We created the Basilar Artery Treatment and MANagement (BATMAN) collaboration, an international multicentre prospective registry aiming to answer clinical questions regarding this devastating and under-researched form of stroke. The overarching aim of this registry is to identify clinical and neuroimaging prognostic factors of outcome and treatment response in patients with posterior circulation stroke. This thesis examines clinical and imaging predictors of outcome in patients with posterior circulation stroke and how they may be applied in clinical practice. The ultimate aim is to push boundaries of treatment in patients with posterior circulation stroke allowing treatment in extended time windows when favourable imaging profiles are present and identify the optimal treatment management for these patients.