From the Research
The recommended treatment for posterior cerebral artery (PCA) occlusion typically involves immediate reperfusion therapy with intravenous thrombolysis using recombinant tissue plasminogen activator (rtPA) at a dose of 0.9 mg/kg (maximum 90 mg) within 4.5 hours of symptom onset, as supported by the most recent study 1.
Key Considerations
- For eligible patients presenting within 24 hours with large vessel occlusion, mechanical thrombectomy may be performed, with a recanalization rate significantly higher than IV-tPA alone 1.
- Secondary prevention includes antiplatelet therapy, high-intensity statin therapy, and strict blood pressure control.
- Risk factor modification is essential, including smoking cessation, diabetes management, and lifestyle modifications.
- Rehabilitation should begin early to address visual field defects, sensory disturbances, and other neurological deficits.
Treatment Details
- Intravenous thrombolysis with rtPA is the mainstay of acute therapy, with a dose of 0.9 mg/kg (maximum 90 mg) within 4.5 hours of symptom onset.
- Mechanical thrombectomy may be performed for eligible patients with large vessel occlusion, with a higher recanalization rate than IV-tPA alone 1.
- Antiplatelet therapy, such as aspirin 81-325 mg daily or clopidogrel 75 mg daily, is recommended for secondary prevention.
- High-intensity statin therapy, such as atorvastatin 40-80 mg or rosuvastatin 20-40 mg daily, is also recommended.
- Strict blood pressure control, with a target <140/90 mmHg, is essential for secondary prevention.
Outcome and Quality of Life
- The outcome and quality of life for patients with PCA occlusion depend on prompt treatment and effective secondary prevention.
- Rehabilitation should begin early to address visual field defects, sensory disturbances, and other neurological deficits.
- The use of antiplatelet agents and heparin for stroke interventions following IV alteplase appears to be safe without significant increased risk of hemorrhagic complications 2.