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Detailed phenotyping of posterior vs. anterior circulation ischemic stroke : a multi-center MRI study

Frid, Petrea LU ; Drake, Mattias LU ; Giese, A. K. ; Wasselius, J. LU ; Schirmer, M. D. ; Donahue, K. L. ; Cloonan, L. ; Irie, R. ; Bouts, M. J.R.J. and McIntosh, E. C. , et al. (2020) In Journal of Neurology 267(3). p.649-658
Abstract

Objective: 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. 

Methods: 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... (More)

Objective: 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. 

Methods: 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. 

Results: 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. 

Conclusion: 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Magnetic resonance imaging, Phenotyping, Posterior circulation brain infarction, Risk factors, Stroke
in
Journal of Neurology
volume
267
issue
3
pages
10 pages
publisher
Steinkopff
external identifiers
  • scopus:85074809145
  • pmid:31709475
ISSN
0340-5354
DOI
10.1007/s00415-019-09613-5
language
English
LU publication?
yes
id
1b2d1cd0-dd05-4aff-830c-a58eb1771da8
date added to LUP
2019-12-09 11:11:24
date last changed
2021-01-19 01:03:40
@article{1b2d1cd0-dd05-4aff-830c-a58eb1771da8,
  abstract     = {<p>Objective: 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. </p><p>Methods: 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. </p><p>Results: 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 &lt; 0.05; male sex 68% vs. 58%, p &lt; 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 &lt; 0.01) and cardioembolic mechanisms (17% vs. 11%, p &lt; 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p &lt; 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. </p><p>Conclusion: 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.</p>},
  author       = {Frid, Petrea and Drake, Mattias and Giese, A. K. and Wasselius, J. and Schirmer, M. D. and Donahue, K. L. and Cloonan, L. and Irie, R. and Bouts, M. J.R.J. and McIntosh, E. C. and Mocking, S. J.T. and Dalca, A. V. and Sridharan, R. and Xu, H. and Giralt-Steinhauer, E. and Holmegaard, Lukas and Jood, Katarina and Roquer, J. and Cole, John W and McArdle, P. F. and Broderick, J. P. and Jimenez-Conde, J. and Jern, Christina and Kissela, B. M. and Kleindorfer, D. O. and Lemmens, Robin and Meschia, J. F. and Rundek, Tatjana and Sacco, R. L. and Schmidt, R. and Sharma, Pankaj and Slowik, A. and Thijs, V. and Woo, D. and Worrall, B. B. and Kittner, Steven J. and Mitchell, B. D. and Petersson, J. and Rosand, Jonathan and Golland, P. and Wu, Ona and Rost, N. S. and Lindgren, A.},
  issn         = {0340-5354},
  language     = {eng},
  number       = {3},
  pages        = {649--658},
  publisher    = {Steinkopff},
  series       = {Journal of Neurology},
  title        = {Detailed phenotyping of posterior vs. anterior circulation ischemic stroke : a multi-center MRI study},
  url          = {http://dx.doi.org/10.1007/s00415-019-09613-5},
  doi          = {10.1007/s00415-019-09613-5},
  volume       = {267},
  year         = {2020},
}