New England Medical Center Posterior Circulation Stroke Registry: I. Methods, Data Base, Distribution of Brain Lesions, Stroke Mechanisms, and Outcomes

Abstract

Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Stroke mechanisms in the posterior and anterior circulation are very similar. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Most distal territory infarcts were attributable to embolism. Thirty day mortality was low (3.6%). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis.

Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry

“…In the NEMC-PCR, Professor Caplan and his team categorized PCS brain lesions as involving proximal, middle, and distal posterior circulation territories and reported that embolism was the most common underlying etiologic mechanism leading to distal events, SVD for middle PCS, and LAA for proximal events. 15 These findings are largely confirmed by our study. While TOAST etiopathogenic classification remains of paramount clinical and prognostic importance, our results indicate that NEMC-PCR topographic classification should be used complementary to TOAST for PCS.…”

Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry

“…In the NEMC-PCR, Professor Caplan and his team categorized PCS brain lesions as involving proximal, middle, and distal posterior circulation territories and reported that embolism was the most common underlying etiologic mechanism leading to distal events, SVD for middle PCS, and LAA for proximal events. 15 These findings are largely confirmed by our study. While TOAST etiopathogenic classification remains of paramount clinical and prognostic importance, our results indicate that NEMC-PCR topographic classification should be used complementary to TOAST for PCS.…”

Multifocal Ischemic Brain Infarctions Secondary to Spontaneous Basilar Artery Occlusion in a Dog with Systemic Thromboembolic Disease

“…However, evidence of global brain ischemia suggests that multifocal brain infarction in this case is more likely caused by the embolic occlusion of the basilar artery alone. Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra‐ and infratentorial areas . In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein …”

“…Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra-and infratentorial areas. 6,11 In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein. 12 In general, ischemic infarction results from vascular obstruction from emboli originating in other vascular beds (artery-to-artery thromboembolism) or from the heart (cardioembolism), or from local thrombus formation within a vessel.…”

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

“…Agreement between CCS and TOAST has been shown to be moderate and differs by subtype [35]. The prevalence of cardioembolic stroke in one study [21] was 24%, while 11% of PCiS in our study was classified as CE. In keeping with several previous studies [7,22,36], cardioembolism was significantly more common in ACiS vs. PCiS.…”

Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry

“…In the NEMC-PCR, Professor Caplan and his team categorized PCS brain lesions as involving proximal, middle, and distal posterior circulation territories and reported that embolism was the most common underlying etiologic mechanism leading to distal events, SVD for middle PCS, and LAA for proximal events. 15 These findings are largely confirmed by our study. While TOAST etiopathogenic classification remains of paramount clinical and prognostic importance, our results indicate that NEMC-PCR topographic classification should be used complementary to TOAST for PCS.…”

Multifocal Ischemic Brain Infarctions Secondary to Spontaneous Basilar Artery Occlusion in a Dog with Systemic Thromboembolic Disease

“…However, evidence of global brain ischemia suggests that multifocal brain infarction in this case is more likely caused by the embolic occlusion of the basilar artery alone. Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra‐ and infratentorial areas . In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein …”

“…Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra-and infratentorial areas. 6,11 In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein. 12 In general, ischemic infarction results from vascular obstruction from emboli originating in other vascular beds (artery-to-artery thromboembolism) or from the heart (cardioembolism), or from local thrombus formation within a vessel.…”

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

“…Agreement between CCS and TOAST has been shown to be moderate and differs by subtype [35]. The prevalence of cardioembolic stroke in one study [21] was 24%, while 11% of PCiS in our study was classified as CE. In keeping with several previous studies [7,22,36], cardioembolism was significantly more common in ACiS vs. PCiS.…”

Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry

“…In the NEMC-PCR, Professor Caplan and his team categorized PCS brain lesions as involving proximal, middle, and distal posterior circulation territories and reported that embolism was the most common underlying etiologic mechanism leading to distal events, SVD for middle PCS, and LAA for proximal events. 15 These findings are largely confirmed by our study. While TOAST etiopathogenic classification remains of paramount clinical and prognostic importance, our results indicate that NEMC-PCR topographic classification should be used complementary to TOAST for PCS.…”

Multifocal Ischemic Brain Infarctions Secondary to Spontaneous Basilar Artery Occlusion in a Dog with Systemic Thromboembolic Disease

“…However, evidence of global brain ischemia suggests that multifocal brain infarction in this case is more likely caused by the embolic occlusion of the basilar artery alone. Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra‐ and infratentorial areas . In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein …”

“…Moreover, this concurs with findings in people and experimental studies in dogs in which BAO often causes multifocal infarction, including in supra-and infratentorial areas. 6,11 In people, a high number of infarcts is associated with a poor clinical outcome, as in the case reported herein. 12 In general, ischemic infarction results from vascular obstruction from emboli originating in other vascular beds (artery-to-artery thromboembolism) or from the heart (cardioembolism), or from local thrombus formation within a vessel.…”

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

“…Agreement between CCS and TOAST has been shown to be moderate and differs by subtype [35]. The prevalence of cardioembolic stroke in one study [21] was 24%, while 11% of PCiS in our study was classified as CE. In keeping with several previous studies [7,22,36], cardioembolism was significantly more common in ACiS vs. PCiS.…”