Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics
Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics
复制标题
DOI：
10.1136/jnnp.2010.211151
复制
发表时间：
2011-01-01
影响因子：
11
通讯作者：
Nedeltchev, Krassen
中科院分区：
文献类型：
--
作者：
De Marchis, Gian Marco;Kohler, Adrian;Nedeltchev, Krassen
背景和目的治疗后循环卒中(PCS)患者的内科医生倾向于更多地争论是否引入抗凝，而不是像前循环卒中(ACS)患者那样进行研究以确定卒中的病因。最近的研究结果表明，PCS和ACS的卒中病因更多的是相似的，而不是不同的，这表明PCS值得与ACS进行同样的研究。方法对312例首次发病的急性冠脉综合征患者和93例首次发病的急性冠脉综合征患者进行前瞻性分析。结果两组患者在人口学特征、血管危险因素发生率、诊断评价和卒中病因学等方面差异无统计学意义。美国国立卫生研究院卒中量表评分的中位数在急性冠脉综合征组为8分，在PCS组为4分(p=0.004)。脑成像显示，与PCS相比，ACS患者更容易发现病理改变。临床结果良好(改良Rankin评分0-2)的未溶栓患者在ACS组和PCS组中的比例相似(67.0%比78.4%；p=0.08)。在未溶栓的患者中，卒中严重程度是急性冠脉综合征患者临床结局的独立预测因子(OR 1.60，95%CI 1.2至2.1；p
Background and purpose Physicians treating patients with posterior circulation strokes (PCS) tended to debate more on whether or not to introduce anticoagulation rather than performing investigations to identify stroke aetiology, as in patients with anterior circulation strokes (ACS). Recent findings suggest that stroke aetiologies of PCS and ACS are more alike than dissimilar, suggesting that PCS deserve the same investigations as ACS. The characteristics and current diagnostic evaluation between patients with PCS and ACS were compared.Methods 312 consecutive patients with first ever ACS and 93 patients with first ever PCS were prospectively analysed.Results Patients with ACS and PCS did not differ in terms of demographic characteristics, prevalence of vascular risk factors, diagnostic evaluation or stroke aetiology. The median National Institutes of Health Stroke Scale score was 8 in ACS and 4 in PCS (p=0.004). Brain imaging revealed more often pathological findings in ACS than PCS. The proportion of non-thrombolysed patients with a favourable clinical outcome (modified Rankin score 0-2) was similar in ACS and PCS (67.0% vs 78.4%; p=0.08). In non-thrombolysed patients, stroke severity was an independent predictor of clinical outcome both in ACS (OR 1.60, 95% CI 1.2 to 2.1; p