Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India.
J Neurol Sci. 2021 Aug 15;427:117499. doi: 10.1016/j.jns.2021.117499. Epub 2021 May 18.
Posterior circulation strokes (PCS) have been less extensively studied than anterior circulation strokes (ACS), especially regarding revascularization therapies. We analyzed the differences in baseline stroke characteristics, revascularization therapy and 3-month outcomes between PCS and ACS in a large prospective multicentre Indian stroke registry.
Patients with acute ischemic stroke recruited in the Indo-US collaborative stroke project from January 2012 to August 2014 were classified into PCS and ACS based on imaging-confirmed infarct location. Demographics, stroke severity, risk factors, and mechanisms were compared. We further compared these parameters in the subgroups who received revascularization therapies (RT) and no revascularization therapies (NRT). The primary outcome was 3-month modified Rankin scale (mRS).
Of 1889 patients (1270 males), 1478 (78.2%) had ACS and 411 (21.8%) PCS. The median NIHSS was lower in PCS (7 vs 11, p < 0.001). Diabetes mellitus and hypertension were more common in PCS and rheumatic heart disease in ACS. Small artery occlusion was higher in PCS (23.8% vs 12.9%, p < 0.001). Only 28 (6.8%) PCS received RT compared to 213 (14.4%) ACS. At 90 days, a good functional outcome (mRS 0-2) was more common in PCS (56.4% vs 45.9%, p < 0.001) in NRT group, while no significant difference was noted in RT group. Stroke territory was not an independent predictor of 3-month outcome in regression analysis. In-hospital mortality was not different between the groups.
The 3-month functional outcome and in-hospital mortality were not different between ACS and PCS. Compared to ACS, PCS received revascularization therapies less often.
与前循环卒中（ACS）相比，后循环卒中（PCS）的研究较少，尤其是在血运重建治疗方面。我们在一项大型的印度前瞻性多中心卒中登记研究中，分析了大样本 PCS 和 ACS 患者的基线卒中特征、血管再通治疗和 3 个月结局的差异。
2012 年 1 月至 2014 年 8 月，印度-美国合作卒中项目中招募的急性缺血性卒中患者，根据影像学证实的梗死部位分为 PCS 和 ACS。比较了两组的人口统计学、卒中严重程度、危险因素和发病机制。我们还比较了接受血管再通治疗（RT）和未接受血管再通治疗（NRT）的亚组之间的这些参数。主要结局是 3 个月时改良 Rankin 量表（mRS）评分。
1889 例患者（男性 1270 例）中，1478 例（78.2%）为 ACS，411 例（21.8%）为 PCS。PCS 的 NIHSS 中位数较低（7 分比 11 分，p<0.001）。PCS 中糖尿病和高血压更为常见，而 ACS 中风湿性心脏病更为常见。小动脉闭塞在 PCS 中较高（23.8%比 12.9%，p<0.001）。仅有 28 例（6.8%）PCS 接受了 RT，而 ACS 中有 213 例（14.4%）。在 NRT 组中，90 天时，PCS 的良好功能结局（mRS 0-2）更为常见（56.4%比 45.9%，p<0.001），而 RT 组则无显著差异。在回归分析中，卒中部位不是 3 个月结局的独立预测因素。两组的住院死亡率无差异。
ACS 和 PCS 的 3 个月功能结局和住院死亡率无差异。与 ACS 相比，PCS 接受血管再通治疗的可能性较小。
