Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study.
Aged
Arterial Occlusive Diseases
/ complications
Basilar Artery
/ pathology
Cerebral Arterial Diseases
/ complications
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuroimaging
Phenotype
Stroke
/ diagnostic imaging
Vertebral Artery
/ pathology
Vertebrobasilar Insufficiency
/ complications
Magnetic resonance imaging
Phenotyping
Posterior circulation brain infarction
Risk factors
Stroke
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
04
09
2019
accepted:
30
10
2019
revised:
28
10
2019
pmc-release:
01
03
2021
pubmed:
12
11
2019
medline:
24
11
2020
entrez:
12
11
2019
Statut:
ppublish
Résumé
Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.
Identifiants
pubmed: 31709475
doi: 10.1007/s00415-019-09613-5
pii: 10.1007/s00415-019-09613-5
pmc: PMC7035231
mid: NIHMS1558800
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
649-658Subventions
Organisme : NINDS NIH HHS
ID : U01 NS080168
Pays : United States
Organisme : NIBIB NIH HHS
ID : P41EB015902
Pays : United States
Organisme : NINDS NIH HHS
ID : NINDS U01 NS080168
Pays : United States
Organisme : NINDS NIH HHS
ID : R01NS100178
Pays : United States
Organisme : NINDS NIH HHS
ID : R01NS086905
Pays : United States
Organisme : Ministerio de Sanidad y Consumo
ID : RD12/0042/0020
Organisme : NINDS NIH HHS
ID : R01 NS100178
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS086905
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK072488
Pays : United States
Organisme : Vetenskapsrådet
ID : 2018-02543
Organisme : NINDS NIH HHS
ID : U01 NS069208
Pays : United States
Organisme : Hjärt-Lungfonden
ID : 20160316
Organisme : NINDS NIH HHS
ID : R01 NS105150
Pays : United States
Organisme : NIBIB NIH HHS
ID : P41 EB015902
Pays : United States
Organisme : NINDS NIH HHS
ID : R01NS105150
Pays : United States
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