In this study, we aimed to evaluate door-to-groin (DTG) time for patients with posterior circulation large vessel occlusion (LVO) who underwent mechanical thrombectomy (MT), and to compare it with patients with LVO in the anterior circulation.

We interrogated our prospectively collected database to identify patients who presented with AIS due to LVO and were treated with MT between 7/2014 and 5/2018. Collected data included demographics, DTG time, baseline National Institutes of Health Stroke Scale (NIHSS), LVO location (anterior Vs. posterior), and 90-day modified Rankin scale (mRS). Multivariate logistic regression was used to examine the relationship between LVO location and 90-day mRS, controlling for potential confounders.

During study period, 471 patients underwent MT, of which 62 (13.2%) had posterior circulation LVO. Patients with posterior circulation LVO were younger (mean age 62.7 +/-16.2 vs. 67.4 +/-14.7; P=0.016). No significant difference was noted in the mean NIHSS on arrival (14.8 Vs. 15.1, P=0.275), or in the rate of receiving intravenous thrombolysis (11.3% vs. 12.2; P=0.833). Median DTG was 97 minutes (IQR 65.25-129.5) for posterior circulation LVOs and 82 minutes (IQR 62.5-101.5) for anterior circulation (P=0.045). Logistic regression analysis showed that LVO location (anterior Vs. posterior) was not independently associated with poor long-term functional outcome (90-day mRS>2) (OR 3.367, 95% CI 0.351-32.298, P=0.293).      

In the studied cohort of stroke patients who underwent MT, posterior circulation LVOs were associated with longer DTG time than anterior LVOs despite having similar baseline NIHSS. Better tools are needed to identify posterior circulation strokes to improve DTG time.