@article{9321353789194f75ace11efb440c35c4,
title = "Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study",
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",
author = "{the Stroke Genetics Network (SiGN), the International Stroke Genetics Consortium (ISGC), and the MRI-Genetics Interface Exploration (MRI-GENIE) Study} and Petrea Frid and Mattias Drake and Giese, {A. K.} and J. Wasselius and Schirmer, {M. D.} and Donahue, {K. L.} and L. Cloonan and R. Irie and Bouts, {M. J.R.J.} and McIntosh, {E. C.} and Mocking, {S. J.T.} and Dalca, {A. V.} and R. Sridharan and H. Xu and E. Giralt-Steinhauer and L. Holmegaard and K. Jood and J. Roquer and Cole, {J. W.} and McArdle, {P. F.} and Broderick, {J. P.} and J. Jimenez-Conde and C. Jern and Kissela, {B. M.} and Kleindorfer, {D. O.} and R. Lemmens and Meschia, {J. F.} and T. Rundek and Sacco, {R. L.} and R. Schmidt and P. Sharma and A. Slowik and V. Thijs and D. Woo and Worrall, {B. B.} and Kittner, {S. J.} and Mitchell, {B. D.} and J. Petersson and J. Rosand and P. Golland and O. Wu and Rost, {N. S.} and A. Lindgren",
note = "Funding Information: Dr. Roquer: supported in part by Spain{\textquoteright}s Ministry of Health (Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III FEDER, RD12/0042/0020). Dr. Jern: The Swedish Research Council (2018-02543), The Swedish Heart and Lung Foundation (20160316) as well as grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-720081). Dr. Meschia: receives funding for the CREST-2 Trial from the NINDS U01 NS080168 and from Mayo Clinic through the Earl and Nyda Swanson Neurosciences Research Fund and the Harley N. and Rebecca N. Hotchkiss Endowed Fund in Neuroscience Research, Honoring Ken and Marietta. Dr. Kittner: supported in part by award number U01NS069208 from the National Institute of Neurological Disorders and Stroke (NINDS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS or the National Institutes of Health. Dr. Kittner{\textquoteright}s effort on this project was partly supported by VA RR&D N1699-R and NINDS R01NS100178 and R01NS105150. Dr. Mitchell: supported in part by SiGN grant for funding R01NS100178. Dr. Rosand: supported in part by US NIH-NINDS R01NS100178 and R01NS086905. Dr. Golland: NIH NIBIB NAC P41EB015902. Dr. Rost: NIH-NINDS R01 NS086905 (MRI-GENIE study/Rost PI). Dr. Lindgren: the Lund Stroke Register has been supported by the Swedish Heart and Lung Foundation, Sk{\aa}ne University Hospital, Region Sk{\aa}ne, the Freemasons Lodge of Instruction EOS in Lund, Foundation of F{\"a}rs and Frosta (one of Sparbanken Sk{\aa}ne{\textquoteright}s ownership Foundations), and Lund University. Acknowledgements Funding Information: 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. Funding Information: Open access funding provided by Lund University. The authors would like to extend their gratitude to the many patients who consented to the use of their clinical and image data. We would like to thank Peter H{\"o}glund, MD, PhD for statistical advice. MDS would like to acknowledge funding from the European Union{\textquoteright}s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie Grant agreement no 753896, outside the submitted work. Publisher Copyright: {\textcopyright} 2019, The Author(s).",
year = "2020",
month = mar,
day = "1",
doi = "10.1007/s00415-019-09613-5",
language = "English (US)",
volume = "267",
pages = "649--658",
journal = "Journal of Neurology",
issn = "0340-5354",
publisher = "D. Steinkopff-Verlag",
number = "3",
}