Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Design: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Setting: Large community-based teaching hospital. Patients: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Main Outcome Measure: Infarct patterns were analyzed according to established templates of vascular territories. Results: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P =.48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P=.6). Conclusions: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

Our results support the use of PSV as a diagnostic criterion for VAo stenosis compared to a PSV ratio of VAo/V1 and VAo/V2.

BackgroundPrevious studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or alleviate these disparities.MethodsAcute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare by TeleSpecialists™ database. The encounters were reviewed for demographics, stroke time metrics, thrombolytics candidate, premorbid modified Rankin Score, NIHSS score, stroke risk factors, antithrombotic use, admitting diagnosis of suspected stroke, and reason not treated with thrombolytic. The treatment rates, door to needle (DTN) times, stroke metric times, and variables of treatment were compared for females and males.ResultsThere were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75–0.97, p = 0.006). Median DTN times were shorter for males than females (38 vs. 41 min, p < 0.001). Male patients were more likely to have an admitting diagnosis of suspected stroke, p < 0.001. Analysis by age showed the only decade with significant difference in thrombolytics treatment rate was 50–59 with increased treatment of males, p = 0.047. When multivariant logistic regression analysis was performed with stroke risk factors, NIHSS score, age, and admitting diagnosis of suspected stroke, the adjusted odds ratio for females was 0.9 (95% CI 0.8, 1.01), p = 0.064.ConclusionWhile treatment differences between sexes existed in the data and were apparent in univariate analysis, no significant difference was seen in multivariate analysis once stroke risk factors, age, NIHSS score and admitting diagnosis were taken into consideration in the telestroke setting. Differences in rates of thrombolysis between sexes may therefore be reflective of differences in risk factors and symptomatology rather than a healthcare disparity.

Objective: Assess for treatment differences by sex and their potential contributors among telestroke evaluations. Background: Studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR as low as 0.57 reported and worse outcomes. With improved access to care through telestroke and updated standards of care, there is potential to reduce or alleviate these disparities. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare TM database. The encounters were reviewed for age, sex, last known normal (LKN), arrival time, consult call time, needle time, thrombolytics candidate, premorbid modified Rankin Score (p-mRS), NIHSS score, screen time, stroke risk factors (hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, coronary artery disease and previous stroke), antithrombotic use, admitting diagnosis of stroke, and reason not treated with thrombolytic. The treatment rates, Door-to-needle (DTN) times, and variables of treatment were compared for females and males. Results: There were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75-0.97, p=0.006). Median DTN times were shorter for males (38 minutes) than females (41 minutes), p<0.001. Male patients were more likely to have an admitting diagnosis of stroke, p <0.001. Female patients <50 and ≥80 years of age were treated at a higher rate than males, while males 50-79 were treated at a higher rate than females. Multivariate analysis of the 50-79 age group did not show a difference in the thrombolytics treatment rates (female 7.6% and male 8.3%, p= 0.752), but did show males had higher rates of all stroke risks factors. Conclusion: While the overall lower treatment rate for females in univariate analysis was consistent with previous studies, the difference was not seen in multivariate analysis. The treatment differences between males and females were negated once the significant sex-based differences in stroke risk factors are taken into consideration.