Differences in Ischemic Anterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis.

TitreDifferences in Ischemic Anterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis.
Publication TypeJournal Article
Year of Publication2019
AuthorsZürcher, E, Richoz, B, Faouzi, M, Michel, P
JournalJournal of stroke and cerebrovascular diseases
Volume28
Issue3
Pagination710-718
Date Published03/2019
DOI10.1016/j.jstrokecerebrovasdis.2018.11.016
ISSN1532-8511
Mots-clés80 and over, Aged, Anterior Cerebral Artery/diagnostic imaging, Anterior Cerebral Artery/drug therapy, Anterior Cerebral Artery/physiopathology, Anterior Cerebral Artery/psychology, anterior circulation, Clinical Neurology, Disability Evaluation, Female, Humans, Infarction, Male, Middle Aged, Neuroimaging/methods, outcome, Posterior Cerebral Artery/diagnostic imaging, Posterior Cerebral Artery/drug therapy, Posterior Cerebral Artery/physiopathology, Posterior Cerebral Artery/psychology, posterior circulation, Predictive Value of Tests, Recovery of Function, Registries, Retrospective Studies, Risk Factors, Switzerland, Thrombolytic Therapy, Time Factors, Treatment Outcome
Abstract

BACKGROUND: There are limited data comparing posterior (PC) and anterior (AC) circulation acute ischemic strokes (AIS). We aimed to identify specific features of PC and AC strokes regarding clinical, etiological, radiological, and outcome factors.

METHODS: Patients from the Acute STroke Registry and Analysis of Lausanne, a prospective cohort of consecutive AIS, from years 2003 to 2008 were included. The stroke territory was determined by a combination of neuroimaging and clinical symptoms. Patients with uncertain localization or with simultaneous AC and PC strokes were excluded. Multivariate associations between territory and multiple variables were investigated.

RESULTS: A total of 1449 patients were included, 466 (32.2%) had a PC territory stroke and 983 (67.8%) an AC. On multivariate analysis, those with PC AIS had lower National Institutes of Health Stroke Scale at admission, more often showed decreased consciousness, visual field defects, and vestibulo-cerebellar signs, but less hemisyndromes, dysarthria, and cognitive symptoms compared to AC AIS patients. Male sex, arterial dissection, lacunar mechanisms, and endovascular recanalization were more frequent in PC strokes, whereas cardioembolic strokes and IV-thrombolysis rates were lower. Less early ischemic signs on admission CT, overall arterial pathology, and 24-hour recanalization were present in PC strokes but intracranial arterial pathology was more prevalent than in AC. The adjusted clinical outcome at 3 months was similar in both groups.

CONCLUSIONS: In this large retrospective consecutive AIS series, there were specific differences in clinical presentation, etiology, and arterial pathology between PC and AC strokes which did not influence clinical outcome. These findings could lead to a tailored diagnostic work-up, acute treatment strategies, and secondary prevention.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/30501979?dopt=Abstract

First publication date (online)

11/2018

WOS ID (UT)

000458177300026

Alternate JournalJ Stroke Cerebrovasc Dis
Citation Key / SERVAL ID9286
Peer reviewRefereed
PubMed ID30501979

                         

IUMSP | www.iumsp.ch
Institut universitaire de médecine sociale et préventive
Route de la Corniche 10, 1010 Lausanne - Switzerland
+41 21 314 72 72 | iumsp@chuv.ch

Go to top