Anterior circulation and posterior circulation ischemic stroke in young adults: a comparison of risk factors, etiologies, imaging features, and long-term outcomes
10.3760/cma.j.issn.1673-4165.2017.12.001
- VernacularTitle:青年前循环与后循环缺血性卒中:危险因素、病因学、影像学特征和远期转归比较
- Author:
Shuanggen ZHU
1
;
Hongbing CHEN
;
Shujin TANG
;
Wenjin SHANG
;
Aiwu ZHANG
;
Wusheng ZHU
Author Information
1. 518109,深圳市龙华区人民医院神经内科
- Keywords:
Stroke;
Brain Ischemia;
Magnetic Resonance Imaging;
Risk Factors;
Prognosis;
Young Adult
- From:
International Journal of Cerebrovascular Diseases
2017;25(12):1057-1065
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the differences of risk factors,imaging features,etiologies,and long-term outcomes in young adults with anterior and posterior circulation ischemic stroke.Methods Consecutive 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.Results A 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％;x2 =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％;x2 =10.435,P =0.001),while small vessel occlusion (26.3％ vs.15.5％;x2 =4.381,P =0.036) and arterial dissection (19.7％ vs.9.9％;x2 =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).Conclusion There 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.
