Clinical Researches
Anterior circulation and posterior circulation ischemic stroke in young adults: a comparison of risk factors, etiologies, imaging features, and long-term outcomes
Shuanggen Zhu, Hongbing Chen, Shujin Tang, Wenjin Shang, Aiwu Zhang, Wusheng Zhu
Published 2017-12-28
Cite as Int J Cerebrovasc Dis, 2017, 25(12): 1057-1065. DOI: 10.3760/cma.j.issn.1673-4165.2017.12.001
Abstract
ObjectiveTo investigate the differences of risk factors, imaging features, etiologies, and long-term outcomes in young adults with anterior and posterior circulation ischemic stroke.
MethodsConsecutive young patients (15-45 years) with ischemic stroke were divided into an anterior circulation group and a posterior circulation group. They were followed up regularly for a long term, and the endpoint events included stroke, cardiovascular events, and death.
ResultsA total of 289 patients were enrolled in the study, including 220 males. Their mean age was 38.0±6.5 years. There were 213 patients (73.7%) in the anterior circulation group and 76 (26.3%) in the posterior circulation group. In terms of risk factors, valvular heart disease was more common in the anterior circulation group (6.6% vs. 0.0%; Fisher's exact test, P=0.025), while hypertension (51.3% vs. 36.6%; χ2=5.021, P=0.025) and prodromic infection (6.6% vs. 1.4%; Fisher's exact test, P=0.018) were more common in the posterior circulation group. In the etiologies of stroke, large-artery atherosclerosis was more common in the anterior circulation group (32.4% vs. 13.2%; χ2=10.435, P=0.001), while small vessel occlusion (26.3% vs. 15.5%; χ2=4.381, P=0.036) and arterial dissection (19.7% vs. 9.9%; χ2=5.012, P=0.025) were more common in the posterior circulation group. There was no significant difference in the incidence of 5-year cumulative end-point events between the anterior circulation group and the posterior circulation group (20.2% vs. 18.5%; log-rank test P=0.614). Multivariate Cox proportional hazards regression analysis showed that after adjusting for age and gender, the independent predictors of end-point events in the posterior circulatory group included hypercholesterolemia (hazard ratio [HR]3.622, 95% confidence interval [CI]1.216-17.766; P=0.030), old infarction (HR 6.045, 95% CI 1.602-29.580; P=0.016), and CE (HR 8.256, 95% CI 1.398-27.302; P=0.029).
ConclusionThere were significant differences in the risk factors, etiologies, and influencing factors of long-term outcome between the anterior circulation and posterior circulation in Chinese young patients with ischemic stroke, suggesting that the different diagnosis and treatment strategies should be adopted for the two types of patients.
Key words:
Stroke; Brain Ischemia; Magnetic Resonance Imaging; Risk Factors; Prognosis; Young Adult
Contributor Information
Shuanggen Zhu
Department of Neurology, the People's Hospital of Longhua District, Shenzhen 518109, China
Hongbing Chen
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Shujin Tang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Wenjin Shang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Aiwu Zhang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Wusheng Zhu
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
