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Comparative Study
. 2017 Jan;48(1):55-62.
doi: 10.1161/STROKEAHA.116.013432. Epub 2016 Nov 17.

Clinical Outcomes of Posterior Versus Anterior Circulation Infarction With Low National Institutes of Health Stroke Scale Scores

Joon-Tae Kim  1 , Man-Seok Park  2 , Kang-Ho Choi  2 , Beom Joon Kim  2 , Moon-Ku Han  2 , Tai Hwan Park  2 , Sang-Soon Park  2 , Kyung Bok Lee  2 , Byung-Chul Lee  2 , Kyung-Ho Yu  2 , Mi Sun Oh  2 , Jae Kwan Cha  2 , Dae-Hyun Kim  2 , Hyun-Wook Nah  2 , Jun Lee  2 , Soo Joo Lee  2 , Youngchai Ko  2 , Jae Guk Kim  2 , Jong-Moo Park  2 , Kyusik Kang  2 , Yong-Jin Cho  2 , Keun-Sik Hong  2 , Jay Chol Choi  2 , Dong-Eog Kim  2 , Wi-Sun Ryu  2 , Dong-Ick Shin  2 , Min-Ju Yeo  2 , Wook-Joo Kim  2 , Juneyoung Lee  2 , Ji Sung Lee  2 , Hee-Joon Bae  2 , Jeffrey L Saver  2 , Ki-Hyun Cho  2
Affiliations
Comparative Study

Clinical Outcomes of Posterior Versus Anterior Circulation Infarction With Low National Institutes of Health Stroke Scale Scores

Joon-Tae Kim et al. Stroke. 2017 Jan.

Abstract

Background and purpose: We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes.

Methods: This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease.

Results: A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups.

Conclusions: Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

Keywords: basilar artery; cerebral infarction; ischemic attack, transient; risk; stroke.

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