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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T2 - Characteristics and predictors of poor outcomes

AU - Chang, Feng Chi

AU - Yong, Chin Sern

AU - Huang, Hui Chi

AU - Tsai, Jui Yao

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.

KW - Arterial dissection

KW - Outcome predictor

KW - Posterior circulation ischemic stroke

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