Etiology and Risk Factors of Posterior Circulation Infarction Compared with Anterior Circulation Infarction.

Abstract

BACKGROUND:

Many clinicians regard posterior circulation infarction (PCI) as different from anterior circulation infarction (ACI), leading them to apply different treatments. Few studies have validated this practice by directly comparing the etiology and risk factors of PCI and ACI.

METHODS:

We compared the etiology and risk factors of 2245 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. Stroke etiology in each patient was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.

RESULTS:

Our sample included 482 patients (21.5%) with PCI and 1763 (78.5%) with ACI. The most frequent etiology for both infarction types was small-artery occlusion, occurring in 37.6% of patients with PCI and 37.1% of those with ACI. Cardioembolism caused infarction in a significantly smaller proportion of patients with PCI (5.4%) than in patients with ACI (13.3%; odds ratio [OR] = .373; 95% confidence interval [CI], .245-.566). Frequencies of other stroke etiologies were similar between the 2 patient groups. Analysis of risk factor frequencies in the 2 groups showed hypertension to be the most common, occurring in 47.9% of patients in either group. Multivariable analysis identified 2 factors as conferring greater risk of PCI than ACI: male gender (OR = 1.392; 95% CI, 1.085-1.786) and diabetes mellitus (OR = 1.667; 95% CI, 1.275-2.180). The same analysis identified 2 factors as conferring greater risk of ACI: atrial fibrillation (OR = .530; 95% CI, .295-.951) and heart valve disease (OR = .433; 95% CI, .203-.922). Frequencies of other possible risk factors were similar between the 2 groups.

CONCLUSIONS:

These findings suggest that PCI and ACI are more similar than different in their etiology and risk factors and that the 2 types of infarction should be treated based more on etiology and risk factors than on their posterior or anterior localization.

• Authors: Quantao Zeng, Wendan Tao, Chunyan Lei, Wei Dong, Ming Liu
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 24 Issue 7 Pg. 1614-20 (Jul 2015) ISSN: 1532-8511 [Electronic] United States
• PMID: 25899158 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Atrial Fibrillation (complications)
• Cerebrovascular Circulation
• Chi-Square Distribution
• China
• Diabetes Complications (etiology)
• Female
• Heart Valve Diseases (complications)
• Humans
• Infarction, Anterior Cerebral Artery (diagnosis, etiology, physiopathology, therapy)
• Infarction, Posterior Cerebral Artery (diagnosis, etiology, physiopathology, therapy)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Prognosis
• Registries
• Risk Factors
• Sex Factors