Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

F. A. V. Anne Pirson*, Nikki Boodt, Josje Brouwer, Agnetha A. E. Bruggeman, Wouter H. Hinsenveld, Julie Staals, Wim H. van Zwam, Christiaan van der Leij, Rutger J. B. Brans, Charles B. L. M. Majoie, Diederik W. J. Dippel, Aad van der Lugt, Wouter J. Schonewille, Robert J. van Oostenbrugge

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: In patients with large vessel occlusion stroke of the anterior circulation, underlying cause is a determinant of
outcome. Whether this is the case for posterior circulation large vessel occlusion stroke has yet to be determined. We aimed
to report on cause in patients with posterior circulation stroke treated with endovascular thrombectomy and to analyze the
association with functional outcome.
METHODS: We used data of patients with posterior circulation stroke included in the MR CLEAN (Multicenter Randomized
Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, a prospective multicenter
observational study, between 2014 and 2018. Stroke cause was categorized into large artery atherosclerosis (LAA),
cardioembolism, arterial dissection, embolic stroke of undetermined source (ESUS), other determined cause, or undetermined
cause. For primary analysis on the association between cause and outcome, we used multivariable ordinal logistic regression
analysis to estimate the adjusted common odds ratio for a shift towards a better functional outcome on the modified Rankin
Scale at 90 days with LAA as a reference group. Secondary outcomes included favorable functional outcome (modified
Rankin Scale score 0–3), National Institutes of Health Stroke Scale score at 24 to 48 hours, reperfusion on digital subtraction
angiography, and stroke progression.
RESULTS: Of 264 patients with posterior circulation stroke, 84 (32%) had LAA, 48 (18%) cardioembolism, 31 (12%)
dissection, and 14 (5%) ESUS. Patients with a dissection were younger (48 [interquartile range, 43–60] years) and
had a lower National Institutes of Health Stroke Scale at baseline (12 [interquartile range, 6–31]) than patients with
other cause. Functional outcome was better for patients with cardioembolism and ESUS compared to LAA (modified
Rankin Scale adjusted common odds ratio, 2.4 [95% CI, 1.1–5.2], respectively adjusted common odds ratio, 3.1 [95% CI,
1.0–9.3]). Patients with a dissection had a lower chance of successful reperfusion compared with LAA (adjusted odds
ratio, 0.20 [95% CI, 0.06–0.70]).
CONCLUSIONS: Unlike the anterior circulation, most frequent cause in our posterior large vessel occlusion stroke cohort is LAA
followed by cardioembolism, dissection, and ESUS. Patients with cardioembolism and ESUS have a better prognosis for
functional outcome after endovascular thrombectomy than patients with LAA.
Original languageEnglish
Pages (from-to)2468-2477
Number of pages10
JournalStroke
Volume53
Issue number8
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
Dr Dippel reports grants for research from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus, all paid to institution. Dr van Zwam reports unrestricted grants from Cerenovus and Stryker European Operations BV, paid to institution. Charles Majoie reports grants from TWIN foundation, related to MR CLEAN registry; paid to institution, and unrelated grants from CVON/Dutch Heart Foundation, European Commission, Dutch Health Evaluation Program, Stryker (all paid to institution), shareholder Nico-lab. The other authors report no conflicts.

Funding Information:
The MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN), Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

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