From the Department of Neurology, Krankenanstalt Rudolfstiftung Vienna, Austria (P.S., E.F.).
Danube University Krems & Gesundheit Österreich GmbH/BIQG, Vienna, Austria (A.P.).
Stroke. 2018 Nov;49(11):2728-2732. doi: 10.1161/STROKEAHA.118.021785.
Background and Purpose- Posterior circulation stroke (PCS) account for 20% of all ischemic strokes. There is limited evidence whether functional outcome of PCS is comparable to that of anterior circulation stroke (ACS). We aimed to analyze whether 3-month functional outcome is different in PCS and ACS. Methods- Patients with acute ischemic stroke prospectively enrolled within the Austrian Stroke Unit Registry were stratified by infarct localization according to the Oxfordshire Community Stroke Project Classification. Propensity score matching was used to control for covariate imbalances and to match patients with PCS and ACS. Patients were matched for stroke severity, recombinant tissue-type plasminogen activator treatment, and demographic and vascular risk factors. Main outcomes were the distribution of modified Rankin Scale after 3 months and multiple proportional odds models to estimate the influence of the infarct localization on the functional outcome. Results- From a total of 90 484 patients enrolled within the Austrian Stroke Unit Registry, 9208 (4604 PCS/4604 ACS) were matched, of those 954 (477 in each group) were treated with recombinant tissue-type plasminogen activator. We detected a significant shift towards better 3-month functional outcome in patients with ACS compared with PCS (odds ratio [OR], 1.19; 95% CI, 1.1-1.28; P<0.0001). In particular, functional outcome was worse in PCS with onset-to-door-time >270 minutes (OR, 1.34; 95% CI, 1.17-1.54; P<0.0001) and in PCS with unknown onset-to-door-time (OR, 1.26; 95% CI, 1.13-1.42; P<0.0001); however, we did not detect any difference in functional outcome between ACS and PCS in patients with an onset-to-door-time ≤270 minutes (1-180 minutes: OR, 0.92, 95% CI, 0.78-1.09, P=0.3554; 181-270 minutes: OR, 1.04, 95% CI, 0.79-1.37, P=0.7689). In patients treated with recombinant tissue-type plasminogen activator, functional outcome was not significantly different between PCS and ACS. Conclusions- PCS was associated with worse outcome compared with ACS in patients arriving later than 4.5 hours at hospital or in those with unknown onset of symptoms. Our results urge for implementation of symptoms found in the posterior circulation into preclinical patient-triage tools.
背景与目的- 后循环卒中（PCS）占所有缺血性卒中的 20%。目前尚缺乏关于 PCS 功能预后是否与前循环卒中（ACS）相当的证据。我们旨在分析 PCS 和 ACS 的 3 个月功能预后是否不同。方法- 前瞻性纳入奥地利卒中单元登记处的急性缺血性卒中患者，根据牛津郡社区卒中项目分类，按梗死部位进行分层。采用倾向评分匹配来控制协变量的不平衡，并匹配 PCS 和 ACS 患者。对患者的卒中严重程度、重组组织型纤溶酶原激活剂治疗以及人口统计学和血管风险因素进行匹配。主要结局为 3 个月时改良 Rankin 量表的分布，以及多比例优势模型来估计梗死部位对功能结局的影响。结果- 在奥地利卒中单元登记处共纳入 90484 例患者，其中 9208 例（4604 例 PCS/4604 例 ACS）进行了匹配，其中 954 例（每组 477 例）接受了重组组织型纤溶酶原激活剂治疗。与 ACS 患者相比，我们发现 PCS 患者的 3 个月功能预后明显更好（比值比 [OR]，1.19；95%置信区间，1.1-1.28；P<0.0001）。特别是，起病至到院时间>270 分钟的 PCS 患者（OR，1.34；95%置信区间，1.17-1.54；P<0.0001）和起病至到院时间未知的 PCS 患者（OR，1.26；95%置信区间，1.13-1.42；P<0.0001）功能预后更差；然而，我们未发现起病至到院时间≤270 分钟的 ACS 和 PCS 患者之间的功能预后存在差异（1-180 分钟：OR，0.92，95%置信区间，0.78-1.09，P=0.3554；181-270 分钟：OR，1.04，95%置信区间，0.79-1.37，P=0.7689）。在接受重组组织型纤溶酶原激活剂治疗的患者中，PCS 和 ACS 的功能预后无显著差异。结论- 与 ACS 相比，起病至到院时间>4.5 小时或起病症状未知的 PCS 患者预后较差。我们的结果敦促将后循环中出现的症状纳入临床前患者分诊工具中。
