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

Journal article
Authors P. Frid
M. Drake
A. K. Giese
J. Wasselius
M. D. Schirmer
K. L. Donahue
L. Cloonan
R. Irie
Mjrj Bouts
E. C. McIntosh
S. J. T. Mocking
A. V. Dalca
R. Sridharan
H. Xu
E. Giralt-Steinhauer
Lukas Holmegaard
Katarina Jood
J. Roquer
J. W. Cole
P. F. McArdle
J. P. Broderick
J. Jimenez-Conde
Christina Jern
B. M. Kissela
D. O. Kleindorfer
R. Lemmens
J. F. Meschia
T. Rundek
R. L. Sacco
R. Schmidt
P. Sharma
A. Slowik
V. Thijs
D. Woo
B. B. Worrall
S. J. Kittner
B. D. Mitchell
J. Petersson
J. Rosand
P. Golland
O. Wu
N. S. Rost
A. Lindgren
Published in Journal of Neurology
Volume 267
Pages 649–658
ISSN 0340-5354
Publication year 2020
Published at Institute of Biomedicine
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 649–658
Language en
Keywords Stroke, Posterior circulation brain infarction, Risk factors, Magnetic, resonance imaging, Phenotyping, risk-factors, causative classification, consecutive patients, cerebral, infarction, subtypes, registry, disease, glucose, sign, Neurosciences & Neurology
Subject categories Neurosciences


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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