Changqing Zhang1, Yilong Wang1, Xingquan Zhao1, Liping Liu1, ChunXue Wang1, Yuehua Pu1, Xinying Zou1, Yuesong Pan1, Ka Sing Wong1, Yongjun Wang2. 1. From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.). 2. From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.). yongjunwang1962@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. METHODS: We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms <7 days. Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS. RESULTS: A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69-10.2; P=0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55-42.5; P<0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00-62.6; P=0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25-23.3; P=0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09-8.58; P=0.03) as independent predictors of recurrent IS or TIA. CONCLUSIONS: Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible.
BACKGROUND AND PURPOSE: Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. METHODS: We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms <7 days. Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS. RESULTS: A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69-10.2; P=0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55-42.5; P<0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00-62.6; P=0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25-23.3; P=0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09-8.58; P=0.03) as independent predictors of recurrent IS or TIA. CONCLUSIONS: Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible.