Clinical Outcomes of Posterior Versus Anterior Circulation Infarction With Low National Institutes of Health Stroke Scale Scores

Abstract

Background and Purpose-We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods-This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results-A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions-Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

Long-term outcome and prognostic factors of posterior circulation ischemia patients: Results from a single center retrospective study

“…13 A Japanese study also found that PCCI with large arterial lesions of the BA had a higher disability rate at three months. 14 In addition, our results also showed high NIHSS score on admission was associated with poor prognosis. The NIHSS score has been widely used to reflect the severity of acute cerebral infarction.…”

High Neutrophil-to-Platelet Ratio Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

“…Data were collected containing demographics (age and gender), risk factors (hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, history of stroke, and cigarette smoking), systolic blood pressure, diastolic blood pressure, the Trial of ORG10172 in the Acute Stroke Treatment (TOAST) classification and treatment in hospital (thrombolysis, antiplatelet and anticoagulation). The stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) at admission (26). Functional outcome was assessed by the Barthel Index (BI) at discharge, and the BI < 60 was defined as poor functional outcome (27).…”

Isolated Anisocoria as a Presenting Stroke Code Symptom is Unlikely to Result in Alteplase Administration

“…Interestingly, 83% of patients without pre-existing anisocoria were noted to have diagnoses with potential involvement of the posterior circulation. Though speculative, this may contribute to the higher NIHSS found in A+(other), as posterior circulation strokes are often associated with poorer prognosis (10,11).…”