Varghese Jeffrin John, Thomas Reji, Vijayalekshmi S, Sasikumar Sheetal, J Jeethu T, N Jisa Merin J
Neurology, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla, IND.
Neurology, Tiruvalla Medical Mission Hospital, Thiruvalla, IND.
Cureus. 2024 Aug 5;16(8):e66172. doi: 10.7759/cureus.66172. eCollection 2024 Aug.
While anterior and posterior circulation strokes share most pathophysiological mechanisms, there is concern that significant differences may exist in some etiopathogenic factors. This study aims to compare the etiologies and risk factors of patients with anterior and posterior circulation strokes to ascertain if the operating mechanisms are any different and warrant different interventions.
A retrospective study compared the etiologies, risk factors, and stroke severity of 350 patients diagnosed with either anterior circulation infarcts (ACI) or posterior circulation infarcts (PCI) confirmed by magnetic resonance imaging. Stroke etiologies were classified according to the Trial of Organization 10172 in Acute Stroke Treatment (TOAST) criteria.
The sample included 254 patients (72.6%) with ACI and 96 patients (27.4%) with PCI. Patients with PCI had a lower mean NIHSS score on admission (6.05 versus 8.70, p<0.001) and a lower mRS score at discharge (1.91 versus 2.48, p=0.004). The most frequent etiology for both types of strokes was large-artery occlusion, occurring in 77.1% of patients with PCI and 61.4% of those with ACI. PCI patients showed a significantly higher proportion of diabetes mellitus (80.2% versus 68.1%, p=0.025) and hypertension (82.2% versus 67.3%, p=0.006) as compared to patients with ACI. Other risk factors and etiologies were similar across both ACI and PCI. Conclusions: Our study of South Indian patients showed that the most critical etiology for ACI and PCI was large artery atherosclerosis (LAA), which was relatively more frequent in patients with PCI. Patients with ACI have more severe strokes compared to PCI. Hypertension and diabetes were the more commonly encountered risk factors for PCI than for ACI. Our results imply that mechanisms of stroke for patients with both ACI and PCI are mostly similar, and treatment should address this correlation rather than focus on other differences. Stricter control of diabetes and hypertension may be warranted for patients with PCI, considering the more significant role attributed to these risk factors in this stroke category.
虽然前循环和后循环卒中具有大多数共同的病理生理机制，但人们担心在某些病因学因素方面可能存在显著差异。本研究旨在比较前循环和后循环卒中患者的病因和危险因素，以确定其发病机制是否不同以及是否需要不同的干预措施。
一项回顾性研究比较了350例经磁共振成像确诊为前循环梗死（ACI）或后循环梗死（PCI）患者的病因、危险因素和卒中严重程度。卒中病因根据急性卒中治疗中组织型纤溶酶原激活剂10172试验（TOAST）标准进行分类。
样本包括254例（72.6%）ACI患者和96例（27.4%）PCI患者。PCI患者入院时的平均美国国立卫生研究院卒中量表（NIHSS）评分较低（6.05对8.70，p<0.001），出院时的改良Rankin量表（mRS）评分也较低（1.91对2.48，p=0.004）。两种类型卒中最常见的病因是大动脉闭塞，在77.1%的PCI患者和61.4%的ACI患者中出现。与ACI患者相比，PCI患者的糖尿病（80.2%对68.1%，p=0.025）和高血压（82.2%对67.3%，p=0.006）比例显著更高。ACI和PCI的其他危险因素和病因相似。
我们对南印度患者的研究表明，ACI和PCI最关键的病因是大动脉粥样硬化（LAA），在PCI患者中相对更常见。与PCI患者相比，ACI患者的卒中更严重。高血压和糖尿病是PCI比ACI更常见的危险因素。我们的结果表明，ACI和PCI患者的卒中机制大多相似，治疗应针对这种相关性，而不是关注其他差异。考虑到这些危险因素在这类卒中中所起的更重要作用，对于PCI患者可能需要更严格地控制糖尿病和高血压。
