Detailed phenotyping of posterior vs. anterior circulation ischemic stroke : a multi-center MRI study
Frid, Petrea (Skåne University Hospital (Suècia))
Drake, Mattias (Skåne University Hospital (Suècia))
Giese, A. K. (Massachusetts Institute of Technology (MIT). Broad Institute)
Wasselius, J. (Skåne University Hospital (Suècia))
Schirmer, M. D. (German Centre for Neurodegenerative Diseases (DZNE). Department of Population Health Sciences)
Donahue, K. L. (Harvard Medical School)
Cloonan, Lisa (Harvard Medical School)
Irie, R. (Harvard Medical School)
Bouts, Mark (Harvard Medical School)
McIntosh, E. C. (Harvard Medical School)
Mocking, S. J. T. (Harvard Medical School)
Dalca, Adrian Vasile (Harvard Medical School)
Sridharan, Ramesh (Massachusetts Institute of Technology (MIT). Computer Science and Artificial Intelligence Laboratory)
Xu, H. (University of Maryland School of Medicine)
Giralt Steinhauer, Eva (Institut Hospital del Mar d'Investigacions Mèdiques)
Holmegaard, Lukas (Sahlgrenska University Hospital (Suècia))
Jood, Katarina (Sahlgrenska University Hospital (Suècia))
Roquer González, Jaume (Institut Hospital del Mar d'Investigacions Mèdiques)
Cole, John W. (University of Maryland School of Medicine)
McArdle, P. F. (University of Maryland School of Medicine)
Broderick, Joseph P (University of Cincinnati College of Medicine. Department of Neurology and Rehabilitation Medicine)
Jimenez-Conde, Jordi (Institut Hospital del Mar d'Investigacions Mèdiques)
Jern, C. (The Sahlgrenska Academy at University of Gothenburg. Institute of Biomedicine)
Kissela, B. M. (University of Cincinnati College of Medicine. Department of Neurology and Rehabilitation Medicine)
Kleindorfer, D. O. (University of Cincinnati College of Medicine. Department of Neurology and Rehabilitation Medicine)
Lemmens, R. (University Hospitals Leuven (Bèlgica))
Meschia, J. F. (Mayo Clinic. Department of Neurology)
Rundek, T. (University of Miami. Department of Neurology)
Sacco, R. L. (University of Miami. Department of Neurology)
Schmidt, Reinhold (Medical University Graz. Clinical Division of Neurogeriatrics, Department of Neurology)
Sharma, P. (Ashford and St Peter's Hospital (Ashford, Regne Unit))
Slowik, A. (Jagiellonian University Medical College. Department of Neurology)
Thijs, V. (Austin Health. Department of Neurology)
Woo, D. (University of Cincinnati College of Medicine. Department of Neurology and Rehabilitation Medicine)
Worrall, B. B. (University of Virginia. Department of Public Health Sciences)
Kittner, S. J. (University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System. Department of Neurology)
Mitchell, B. D. (Veterans Administration Medical Center. Geriatric Research and Education Clinical Center)
Petersson, J. (Skåne University Hospital (Suècia))
Rosand, J. (Massachusetts General Hospital (Boston))
Golland, P. (Massachusetts Institute of Technology (MIT). Computer Science and Artificial Intelligence Laboratory)
Wu, O. (Harvard Medical School)
Rost, N. S. (Massachusetts General Hospital (Boston))
Lindgren, A. (Skåne University Hospital (Suècia))
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0. 05 ; male sex 68% vs. 58%, p < 0. 001). Both were independently associated with PCiS (diabetes, OR = 1. 29; 95% CI 1. 04-1. 61; male sex, OR = 1. 46; 95% CI 1. 21-1. 78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0. 01) and cardioembolic mechanisms (17% vs. 11%, p < 0. 001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0. 001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS. The online version of this article (10. 1007/s00415-019-09613-5) contains supplementary material, which is available to authorized users.
Ajuts:	European Commission 753896 Instituto de Salud Carlos III RD12-0042-0020
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Stroke ; Posterior circulation brain infarction ; Risk factors ; Magnetic resonance imaging ; Phenotyping
Publicat a:	Journal of Neurology, Vol. 267 (november 2019) , p. 649-658, ISSN 1432-1459

DOI: 10.1007/s00415-019-09613-5
PMID: 31709475

10 p, 806.0 KB

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