Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

Abstract

Distinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.

Outcome predictors in anterior and posterior ischemic strokes: a study based on the Iranian SITS registry

“…In four studies, the female sex was higher in ACS cases, contrary to De Marchis and our study, which was the same in both sexes 4 , 5 , 8 , 9 , 13 .…”

“…In a study on 18-month follow-up of IVT cases, there was 34.3% mortality, possibly making acceptable a mortality rate of 17.75% after a 3-month follow-up in the present work. PCS cases were about 7.00% of IVT therapy cases in this study, while in ours, it was about 4.60%; in other studies, more cases were reported compared to ours 4 , 5 , 9 , 20 , 22 . This difference could be due to the delay in diagnosis and admission of our PCS cases and fewer data collection.…”

“…Diabetes was less in PCS cases than ACS, as in Handelsmann et al study and the opposite is true in Cui et al, Tong et al, and Kim et al study. There was no difference in diabetes between ACS and PCS in the current study as in De Marchis 8 , 9 , 13 , 22 .…”

“…According to Handelsman et al, ACS cases with aging had a worse prognosis than those of PCS. They showed NIHSS as an essential predicting factor for the functional state in both territories, with no difference in their outcomes 9 .…”

Radiomics Analysis of Diffusion-Weighted Imaging and Long-Term Unfavorable Outcomes Risk for Acute Stroke

“…AIS outcomes depend on the clinical setting and patient demographics as well as on a multitude of variables associated with cerebral core infarction, perfusion, etc. 1–3 Information management strategies for AIS are helpful for improving the prediction of clinical prognosis. Many studies have attempted to combine these prognostic factors into standardized scores or use machine learning to predict clinical outcomes.…”