Research Article

Risk Factors, Biomarkers, Etiologic Subtypes, Outcome and Prognosis of Posterior Circulation Ischemic Strokes

10.1501/Tipfak_0000000898

  • Mine Hayriye Sorgun
  • Seyda Erdoğan
  • Müge Kuzu
  • İnci Șule Gül
  • Hafize Çotur
  • Çağrı Ulukan
  • Sefer Rızayev
  • Volkan Yılmaz
  • Sabiha Tezcan
  • Anwar Rawandi
  • Canan Togay Ișıkay

Received Date: 22.07.2015 Accepted Date: 02.10.2015 J Ankara Univ Fac Med 2015;68(3):103-106

Introduction:

Acute infarcts in posterior circulation (AIPC) have been reported 16-39.8% of ischemic stroke patients in previous studies. The most frequent cause of AIPC was embolism from cardio-aortic, vertebra-basilar atherosclerosis or dissection, followed by large-artery atherosclerosis (LAA), small vessel disease and other causes. The aim of this study was to determine the etiologic subtypes of AIPC in our stroke registry.

Methods:

We reviewed the charts of 554 patients who were admitted with acute ischemic stroke between the dates January 2011 and August 2014. The demographic data, the National Institutes of Health Stroke Scale (NIHSS) scores at admission and detailed investigations to determine etiologic focus of stroke were recorded. We determined etiologic stroke subtypes using the automated Causative Classification System (CCS). The modified Rankin Scale (mRS) scores were recorded in follow-up period

Results:

A total of 184 (40.6%) patients with AIPC (89 females [48.4%] and 95 males [51.6%]; mean age, 70.6±12.5 [25-92] years) and 268 (59.3%) patients with acute infarcts in anterior circulation (AIAC) (133 females [49.6%] and 135 males [50.4%]; mean age, 69.3±13.7 [28-103] years) were included in the study. History of diabetes and previous stroke were significantly more common in patients with AIPC compared to the patients with AIAC (p=0.04, p=0.009). The mean admission NIHSS score was 6.4± 4.6 (0-26) in patients with AIPC (Group 1) and 6.7±4.3 (0-23) in patients with AIAC (Group 2) (p=0.96). cardio -aortic embolism was more common in Group 2 compared to Group 1, but not significant (p = 0.12). There was no significant difference in the mean C-reactive protein (CRP) level between two groups (p=0.23). Mortality in hospital was 14.7% (n=27) in Group 1 and 8.6% (n=23) in group 2 (p = 0.04). The median mRS was 3 (0-6) in patients with AIPC and 2 (0-6) in patients with AIAC during follow up period (p=0.79). Recurrent stroke occurred in 1 (0.5%) patient with AIPC and 8 (3%) patients with AIAC (p=0.07).

Conclusion:

AIPC was found in 40.6% of patients with acute ischemic stroke in this registry. Cardio-aortic embolism was the most common cause of AIPC group. Diabetes and previous stroke history appear to be the major risk factors for AIPC. Mortality in hospital was significantly higher in AIPC group.

Keywords: Acute Infarcts in Posterior Circulation, Risk Factors, Etiologic Subtypes, Outcome, Prognosis