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April 1998

Stroke 1998

Arch Neurol. 1998;55(4):448. doi:10.1001/archneur.55.4.448

IN THIS issue of the ARCHIVES and the April 22/29 issue of JAMA, attention is being directed toward important, emerging areas involving the treatment, prevention, and outcome predictors of stroke. A vital area of clinical research interest is posterior circulation ischemia and stroke. Our knowledge of posterior circulation disease has not developed as completely as that of anterior circulation. Therapy for vertebrobasilar disease has remained an area of intense controversy. Caplan1 establishes perspective and cautions us in his lead editorial in this issue when he advises us how to proceed with the latest therapeutic modality, recombinant tissue-typplasminogen activator, in patients of the kind described by Grond et al2 with vertebrobasilar stroke. Of considerable interest is that Grond et al2 found a favorable outcome in the majority of their patients with vertebrobasilar stroke when they were treated with intravenous recombinant tissue-type plasminogen activator and heparin within 3 hours of symptom onset. The experience of the New England Medical Center Posterior Circulation Registry complements this series by describing the clinical features of 80 patients with occlusive disease of the proximal segment of the vertebral artery, as reported by Wityk et al.3 Before we can be definitive about therapy in this vascular territory, we need to appreciate more fully the natural history and biology of these lesions, which these articles in this issue of the ARCHIVES provide.