Posterior circulation ischemic stroke caused by arterial dissection

Characteristics and predictors of poor outcomes

Feng Chi Chang, Chin Sern Yong, Hui Chi Huang, Jui Yao Tsai, Wen Yung Sheng, Han Hwa Hu, Chih Ping Chung

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7%) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8% of patients, respectively. The location of AD was initiated in the vertebral artery (66.2%), basilar artery (27.0%), posterior inferior cerebellar artery (5.4%) and posterior cerebral artery (1.4%). The involvement of intracranial arteries was present in the majority of patients (97.3%). Of the patients, 9.5% died, and 29.7% had poor functional outcomes (modified Rankin Scale ≥4) at 3-month. Conscious change independently predicted mortality at 3 months. Quadriparesis, National Institutes of Health Stroke Scale (NIHSS) score >8 and infarct lesions involving >1 category were independent predictors for poor functional outcomes at 3 months. Conclusion: AD is an important etiology of PCS. Physicians should be more vigilant in recognizing AD-PCS. Intracranial arteries are more important in AD-PCS; very few patients of AD-PCS had dissection solely in extracranial arteries. Short-term outcomes of AD-PCS were not favorable. Conscious change, quadriparesis, NIHSS score >8 and infarct lesions involving >1 category were independent predictors for poor outcomes. Patients presenting these factors should be monitored closely.

Original languageEnglish
Pages (from-to)144-150
Number of pages7
JournalCerebrovascular Diseases
Volume40
Issue number3-4
DOIs
Publication statusPublished - Dec 1 2015
Externally publishedYes

Fingerprint

Dissection
Stroke
Arteries
Quadriplegia
National Institutes of Health (U.S.)
Posterior Cerebral Artery
Veterans Hospitals
Basilar Artery
Vertebral Artery
Neck Pain
General Hospitals
Headache
Registries

Keywords

  • Arterial dissection
  • Outcome predictor
  • Posterior circulation ischemic stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Posterior circulation ischemic stroke caused by arterial dissection : Characteristics and predictors of poor outcomes. / Chang, Feng Chi; Yong, Chin Sern; Huang, Hui Chi; Tsai, Jui Yao; Sheng, Wen Yung; Hu, Han Hwa; Chung, Chih Ping.

In: Cerebrovascular Diseases, Vol. 40, No. 3-4, 01.12.2015, p. 144-150.

Research output: Contribution to journalArticle

Chang, Feng Chi ; Yong, Chin Sern ; Huang, Hui Chi ; Tsai, Jui Yao ; Sheng, Wen Yung ; Hu, Han Hwa ; Chung, Chih Ping. / Posterior circulation ischemic stroke caused by arterial dissection : Characteristics and predictors of poor outcomes. In: Cerebrovascular Diseases. 2015 ; Vol. 40, No. 3-4. pp. 144-150.
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abstract = "Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7{\%}) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8{\%} of patients, respectively. The location of AD was initiated in the vertebral artery (66.2{\%}), basilar artery (27.0{\%}), posterior inferior cerebellar artery (5.4{\%}) and posterior cerebral artery (1.4{\%}). The involvement of intracranial arteries was present in the majority of patients (97.3{\%}). Of the patients, 9.5{\%} died, and 29.7{\%} had poor functional outcomes (modified Rankin Scale ≥4) at 3-month. Conscious change independently predicted mortality at 3 months. Quadriparesis, National Institutes of Health Stroke Scale (NIHSS) score >8 and infarct lesions involving >1 category were independent predictors for poor functional outcomes at 3 months. Conclusion: AD is an important etiology of PCS. Physicians should be more vigilant in recognizing AD-PCS. Intracranial arteries are more important in AD-PCS; very few patients of AD-PCS had dissection solely in extracranial arteries. Short-term outcomes of AD-PCS were not favorable. Conscious change, quadriparesis, NIHSS score >8 and infarct lesions involving >1 category were independent predictors for poor outcomes. Patients presenting these factors should be monitored closely.",
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AU - Chang, Feng Chi

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AU - Sheng, Wen Yung

AU - Hu, Han Hwa

AU - Chung, Chih Ping

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AB - Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7%) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8% of patients, respectively. The location of AD was initiated in the vertebral artery (66.2%), basilar artery (27.0%), posterior inferior cerebellar artery (5.4%) and posterior cerebral artery (1.4%). The involvement of intracranial arteries was present in the majority of patients (97.3%). Of the patients, 9.5% died, and 29.7% had poor functional outcomes (modified Rankin Scale ≥4) at 3-month. Conscious change independently predicted mortality at 3 months. Quadriparesis, National Institutes of Health Stroke Scale (NIHSS) score >8 and infarct lesions involving >1 category were independent predictors for poor functional outcomes at 3 months. Conclusion: AD is an important etiology of PCS. Physicians should be more vigilant in recognizing AD-PCS. Intracranial arteries are more important in AD-PCS; very few patients of AD-PCS had dissection solely in extracranial arteries. Short-term outcomes of AD-PCS were not favorable. Conscious change, quadriparesis, NIHSS score >8 and infarct lesions involving >1 category were independent predictors for poor outcomes. Patients presenting these factors should be monitored closely.

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KW - Outcome predictor

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