Multicenter Study

. 2020 Mar;267(3):649-658.

doi: 10.1007/s00415-019-09613-5. Epub 2019 Nov 11.

Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

Petrea Frid^{1

2

3}, Mattias Drake^{4

5}, A K Giese^{6

7}, J Wasselius^{4

5}, M D Schirmer^{6

8

9}, K L Donahue⁶, L Cloonan⁶, R Irie¹⁰, M J R J Bouts¹⁰, E C McIntosh¹⁰, S J T Mocking¹⁰, A V Dalca^{8

10}, R Sridharan⁸, H Xu¹¹, E Giralt-Steinhauer¹², L Holmegaard^{13

14}, K Jood^{13

14}, J Roquer¹², J W Cole¹⁵, P F McArdle¹¹, J P Broderick¹⁶, J Jimenez-Conde¹², C Jern¹⁷, B M Kissela¹⁶, D O Kleindorfer¹⁶, R Lemmens^{18

19

20}, J F Meschia²¹, T Rundek²², R L Sacco²², R Schmidt²³, P Sharma^{24

25}, A Slowik²⁶, V Thijs^{27

28}, D Woo¹⁶, B B Worrall^{29

30}, S J Kittner¹⁵, B D Mitchell^{11

31}, J Petersson^{32

33}, J Rosand^{6

7

10

34

35}, P Golland⁸, O Wu¹⁰, N S Rost⁶, A Lindgren^{32

36}; Stroke Genetics Network (SiGN), the International Stroke Genetics Consortium (ISGC), and the MRI-Genetics Interface Exploration (MRI-GENIE) Study

Affiliations

¹ Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden. petrea.frid@med.lu.se.
² Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden. petrea.frid@med.lu.se.
³ Department of Neurology, Skåne University Hospital, Jan Waldenströms gata 19, 205 02, Malmö, Sweden. petrea.frid@med.lu.se.
⁴ Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
⁵ Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden.
⁶ J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁸ Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA.
⁹ Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
¹⁰ Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA.
¹¹ Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
¹² Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.
¹³ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁴ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁵ Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
¹⁶ Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁷ Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Louvain, Belgium.
¹⁹ VIB Center for Brain and Disease Research, Louvain, Belgium.
²⁰ Department of Neurology, University Hospitals Leuven, Louvain, Belgium.
²¹ Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
²² Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
²³ Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria.
²⁴ Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK.
²⁵ Ashford and St Peter's Hospital, Ashford, UK.
²⁶ Department of Neurology, Jagiellonian University Medical College, Kraków, Poland.
²⁷ Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
²⁸ Department of Neurology, Austin Health, Heidelberg, Australia.
²⁹ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
³⁰ Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
³¹ Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, USA.
³² Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
³³ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden.
³⁴ Center for Genomic Research, Massachusetts General Hospital, Boston, MA, USA.
³⁵ Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA.
³⁶ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden.

PMID: 31709475
PMCID: PMC7035231
DOI: 10.1007/s00415-019-09613-5

Multicenter Study

Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

Petrea Frid et al. J Neurol. 2020 Mar.

. 2020 Mar;267(3):649-658.

doi: 10.1007/s00415-019-09613-5. Epub 2019 Nov 11.

Authors

Affiliations

¹ Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden. petrea.frid@med.lu.se.
² Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden. petrea.frid@med.lu.se.
³ Department of Neurology, Skåne University Hospital, Jan Waldenströms gata 19, 205 02, Malmö, Sweden. petrea.frid@med.lu.se.
⁴ Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
⁵ Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden.
⁶ J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁸ Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA.
⁹ Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany.
¹⁰ Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA.
¹¹ Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
¹² Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.
¹³ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁴ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁵ Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
¹⁶ Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁷ Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Louvain, Belgium.
¹⁹ VIB Center for Brain and Disease Research, Louvain, Belgium.
²⁰ Department of Neurology, University Hospitals Leuven, Louvain, Belgium.
²¹ Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
²² Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
²³ Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria.
²⁴ Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK.
²⁵ Ashford and St Peter's Hospital, Ashford, UK.
²⁶ Department of Neurology, Jagiellonian University Medical College, Kraków, Poland.
²⁷ Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
²⁸ Department of Neurology, Austin Health, Heidelberg, Australia.
²⁹ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
³⁰ Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
³¹ Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, USA.
³² Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
³³ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden.
³⁴ Center for Genomic Research, Massachusetts General Hospital, Boston, MA, USA.
³⁵ Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA.
³⁶ Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden.

PMID: 31709475
PMCID: PMC7035231
DOI: 10.1007/s00415-019-09613-5

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Magnetic resonance imaging; Phenotyping; Posterior circulation brain infarction; Risk factors; Stroke.

PubMed Disclaimer

Conflict of interest statement

PF, MD, AKG, JW, MDS, KLD, LC, RI, MJRJB, ECM, AVD, RS, HX, EGS, LH, KJ, J Roquer, JWC, PFMA, JPB, JJC, CJ, BMK, DOK, RL, JFM, TR, RLS, RS, PS, AS, DW, BBW, SJK, BDM, PG, and JP: None. SJTM reports personal fees from Alphabet, Inc., outside the submitted work; VT reports grants from NINDS funding, during the conduct of the study; personal fees and non-financial support from Boehringer Ingelheim, personal fees from Pfizer, personal fees from Medtronic, personal fees from Amgen, personal fees from Bayer, outside the submitted work; J Rosand reports personal fees from Boehringer Ingelheim, Pfizer, and New Beta Innovations, outside the submitted work; OW reports grants from NIH-NINDS, during the conduct of the study; personal fees from Penumbra, Inc and Genentech, outside the submitted work; NSR reports grants from National Institutes of Health, during the conduct of the study; AL reports personal fees from Bayer, BMS/Pfizer, Astra Zeneca, and Boehringer Ingelheim, outside the submitted work.

Figures

**Fig. 1**
Proportion of ischemic stroke subtypes in ACiS vs. PCiS. *ACiS* anterior circulation ischemic stroke, *PCiS* posterior circulation ischemic stroke, CE cardioembolism, *LAA* large artery atherosclerosis, *SAO* small artery occlusion

**Fig. 2**
DWI lesion location and ischemic stroke subtype in PCiS. *PCiS* posterior circulation ischemic stroke, CE cardioembolism, *LAA* large artery atherosclerosis, *SAO* small artery occlusion

See this image and copyright information in PMC

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Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

Affiliations

Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical