Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 5;16(8):e66172.
doi: 10.7759/cureus.66172. eCollection 2024 Aug.

Etiologies and Risk Factors of Anterior and Posterior Circulation Strokes: A Comparison Study From South India

Jeffrin John Varghese  1 , Reji Thomas  1 , S Vijayalekshmi  1 , Sheetal Sasikumar  2 , Jeethu T J  1 , Jisa Merin J N  1
Affiliations

Etiologies and Risk Factors of Anterior and Posterior Circulation Strokes: A Comparison Study From South India

Jeffrin John Varghese et al. Cureus. .

Abstract

Introduction: While anterior and posterior circulation strokes share most pathophysiological mechanisms, there is concern that significant differences may exist in some etiopathogenic factors. This study aims to compare the etiologies and risk factors of patients with anterior and posterior circulation strokes to ascertain if the operating mechanisms are any different and warrant different interventions.

Methods: A retrospective study compared the etiologies, risk factors, and stroke severity of 350 patients diagnosed with either anterior circulation infarcts (ACI) or posterior circulation infarcts (PCI) confirmed by magnetic resonance imaging. Stroke etiologies were classified according to the Trial of Organization 10172 in Acute Stroke Treatment (TOAST) criteria.

Results: The sample included 254 patients (72.6%) with ACI and 96 patients (27.4%) with PCI. Patients with PCI had a lower mean NIHSS score on admission (6.05 versus 8.70, p<0.001) and a lower mRS score at discharge (1.91 versus 2.48, p=0.004). The most frequent etiology for both types of strokes was large-artery occlusion, occurring in 77.1% of patients with PCI and 61.4% of those with ACI. PCI patients showed a significantly higher proportion of diabetes mellitus (80.2% versus 68.1%, p=0.025) and hypertension (82.2% versus 67.3%, p=0.006) as compared to patients with ACI. Other risk factors and etiologies were similar across both ACI and PCI. Conclusions: Our study of South Indian patients showed that the most critical etiology for ACI and PCI was large artery atherosclerosis (LAA), which was relatively more frequent in patients with PCI. Patients with ACI have more severe strokes compared to PCI. Hypertension and diabetes were the more commonly encountered risk factors for PCI than for ACI. Our results imply that mechanisms of stroke for patients with both ACI and PCI are mostly similar, and treatment should address this correlation rather than focus on other differences. Stricter control of diabetes and hypertension may be warranted for patients with PCI, considering the more significant role attributed to these risk factors in this stroke category.

Keywords: anterior circulation infarction; etiology; posterior circulation infarction; risk factors; stroke.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Pushpagiri Institute of Medical Sciences & Research Centre issued approval PIMSRC/E1/388A/2/2020. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (IEC Approval No: PIMSRC/E1/388A/2/2020 ) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Mean age of subjects with standard deviation
ACI: Anterior Circulation Infarction, PCI: Posterior Circulation Infarction
Figure 2
Figure 2. Mean NIHSS score of subjects with standard deviation
ACI: Anterior Circulation Infarction, PCI: Posterior Circulation Infarction, NIHSS: National Institute of Health Stroke Scale
Figure 3
Figure 3. Mean mRS score of subjects with standard deviation
ACI: Anterior Circulation Infarction, PCI: Posterior Circulation Infarction, mRS: modified Rankin Scale
See this image and copyright information in PMC

References

    1. Vertebrobasilar disease. Savitz SI, Caplan LR. N Engl J Med. 2005;352:2618–2626. - PubMed
    1. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Caplan L. Stroke. 2000;31:2011–2023. - PubMed
    1. False-negative initial magnetic resonance imaging in acute posterior circulation stroke: a case report describing locked-in syndrome. Castaneda CL, Rhee JA, Woo JH, Lerario MP. Cureus. 2020;12:0. - PMC - PubMed
    1. Cerebrovascular disease in the community: results of a WHO Collaborative Study. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395897/pdf/bullwho00424-01.... Bull World Health Organ. 1980;58:113–130. - PMC - PubMed
    1. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Stroke. 1993;24:35–41. - PubMed

LinkOut - more resources