Department of Neurology, School for Cardiovascular Diseases (CARIM) (F.A.V.(A).P., W.H.H., J.S., R.J.v.O.), Maastricht University Medical Center, the Netherlands.
Department of Neurology (N.B., D.W.J.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Stroke. 2022 Aug;53(8):2468-2477. doi: 10.1161/STROKEAHA.121.038054. Epub 2022 May 11.
In patients with large vessel occlusion stroke of the anterior circulation, underlying cause is a determinant of outcome. Whether this is the case for posterior circulation large vessel occlusion stroke has yet to be determined. We aimed to report on cause in patients with posterior circulation stroke treated with endovascular thrombectomy and to analyze the association with functional outcome.
We used data of patients with posterior circulation stroke included in the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, a prospective multicenter observational study, between 2014 and 2018. Stroke cause was categorized into large artery atherosclerosis (LAA), cardioembolism, arterial dissection, embolic stroke of undetermined source (ESUS), other determined cause, or undetermined cause. For primary analysis on the association between cause and outcome, we used multivariable ordinal logistic regression analysis to estimate the adjusted common odds ratio for a shift towards a better functional outcome on the modified Rankin Scale at 90 days with LAA as a reference group. Secondary outcomes included favorable functional outcome (modified Rankin Scale score 0-3), National Institutes of Health Stroke Scale score at 24 to 48 hours, reperfusion on digital subtraction angiography, and stroke progression.
Of 264 patients with posterior circulation stroke, 84 (32%) had LAA, 48 (18%) cardioembolism, 31 (12%) dissection, and 14 (5%) ESUS. Patients with a dissection were younger (48 [interquartile range, 43-60] years) and had a lower National Institutes of Health Stroke Scale at baseline (12 [interquartile range, 6-31]) than patients with other cause. Functional outcome was better for patients with cardioembolism and ESUS compared to LAA (modified Rankin Scale adjusted common odds ratio, 2.4 [95% CI, 1.1-5.2], respectively adjusted common odds ratio, 3.1 [95% CI, 1.0-9.3]). Patients with a dissection had a lower chance of successful reperfusion compared with LAA (adjusted odds ratio, 0.20 [95% CI, 0.06-0.70]).
Unlike the anterior circulation, most frequent cause in our posterior large vessel occlusion stroke cohort is LAA followed by cardioembolism, dissection, and ESUS. Patients with cardioembolism and ESUS have a better prognosis for functional outcome after endovascular thrombectomy than patients with LAA.
在前循环大血管闭塞性卒中患者中，病因是预后的决定因素。这种情况在后循环大血管闭塞性卒中患者中是否成立尚待确定。我们旨在报告接受血管内血栓切除术治疗的后循环卒中患者的病因，并分析其与功能结局的关系。
我们使用了 2014 年至 2018 年期间纳入 MR CLEAN（荷兰多中心急性缺血性卒中血管内治疗随机对照试验）登记处的后循环卒中患者的数据，这是一项前瞻性多中心观察性研究。卒中病因分为大动脉粥样硬化（LAA）、心源性栓塞、动脉夹层、不明来源的栓塞性卒中（ESUS）、其他确定病因或不明病因。对于病因与结局之间关联的主要分析，我们使用多变量有序逻辑回归分析来估计改良 Rankin 量表 90 天时功能结局改善的调整后的常见比值比，以 LAA 为参考组。次要结局包括良好的功能结局（改良 Rankin 量表评分 0-3）、24 至 48 小时时的国立卫生研究院卒中量表评分、数字减影血管造影再灌注和卒中进展。
在 264 例后循环卒中患者中，84 例（32%）为 LAA，48 例（18%）为心源性栓塞，31 例（12%）为夹层，14 例（5%）为 ESUS。夹层患者较年轻（48 [四分位距，43-60] 岁），基线时国立卫生研究院卒中量表评分较低（12 [四分位距，6-31]）。与其他病因相比，心源性栓塞和 ESUS 患者的功能结局更好（改良 Rankin 量表调整后的常见比值比，2.4 [95%置信区间，1.1-5.2]；分别调整后的常见比值比，3.1 [95%置信区间，1.0-9.3]）。与 LAA 相比，夹层患者成功再灌注的可能性较低（调整后的优势比，0.20 [95%置信区间，0.06-0.70]）。
与前循环不同，我们的后循环大血管闭塞性卒中队列中最常见的病因是 LAA，其次是心源性栓塞、夹层和 ESUS。与 LAA 相比，心源性栓塞和 ESUS 患者接受血管内血栓切除术治疗后的功能结局预后更好。
