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.

Keywords:
Arterial dissection, Posterior circulation ischemic stroke, Outcome predictor
1.
Bogousslavsky J, Van Melle G, Regli F: The Lausanne stroke registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988;19:1083-1092.
2.
Markus HS, van der Worp HB, Rothwell PM: Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol 2013;12:989-998.
3.
Merwick Á, Werring D: Posterior circulation ischaemic stroke. BMJ 2014;348:g3175.
4.
Kim JS, Nah HW, Park SM, Kim SK, Cho KH, Lee J, Lee YS, Kim J, Ha SW, Kim EG, Kim DE, Kang DW, Kwon SU, Yu KH, Lee BC: Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anterior compared with posterior circulation disease. Stroke 2012;43:3313-3318.
5.
Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS: New England medical center posterior circulation registry. Ann Neurol 2004;56:389-398.
6.
Chung CP, Yong CS, Chang FC, Sheng WY, Huang HC, Tsai JY, Hsu HY, Hu HH: Stroke etiology is associated with outcome in posterior circulation stroke. Ann Clin Transl Neurol 2015;2:510-517.
7.
Caplan L, Chung CS, Wityk R, Glass T, Tapia J, Pazdera L, Chang HM, Dashe J, Chaves C, Vemmos K, Leary M, Dewitt L, Pessin M: New England medical center posterior circulation stroke registry: I. Methods, data base, distribution of brain lesions, stroke mechanisms, and outcomes. J Clin Neurol 2005;1:14-30.
8.
Lee JH, Han SJ, Yun YH, Choi HC, Jung S, Cho SJ, Yu KH, Lee SM, Hwang SH, Song HK, Kwon KH, Lee BC: Posterior circulation ischemic stroke in Korean population. Eur J Neurol 2006;13:742-748.
9.
Mehndiratta M, Pandey S, Nayak R, Alam A: Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a north Indian population: a prospective study. Neurohospitalist 2012;2:46-50.
10.
Arnold M, Kurmann R, Galimanis A, Sarikaya H, Stapf C, Gralla J, Georgiadis D, Fischer U, Mattle HP, Bousser MG, Baumgartner RW: Differences in demographic characteristics and risk factors in patients with spontaneous vertebral artery dissections with and without ischemic events. Stroke 2010;41:802-804.
11.
Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T: Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 1999;30:1083-1090.
12.
Ali MS, Amenta PS, Starke RM, Jabbour PM, Gonzalez LF, Tjoumakaris SI, Flanders AE, Rosenwasser RH, Dumont AS: Intracranial vertebral artery dissections: evolving perspectives. Interv Neuroradiol 2012;18:469-483.
13.
Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, Benninger D, Sturzenegger M, Mattle HP, Baumgartner RW: Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006;37:2499-2503.
14.
Huang YC, Chen YF, Wang YH, Tu YK, Jeng JS, Liu HM: Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol 2009;72(suppl 2):S20-S27; discussion S27.
15.
Tsukahara T, Minematsu K: Overview of spontaneous cervicocephalic arterial dissection in Japan. Acta Neurochir Suppl 2010;107:35-40.
16.
Kim BM, Kim SH, Kim DI, Shin YS, Suh SH, Kim DJ, Park SI, Park KY, Ahn SS: Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 2011;76:1735-1741.
17.
Yamaura A, Ono J, Hirai S: Clinical picture of intracranial non-traumatic dissecting aneurysm. Neuropathology 2000;20:85-90.
18.
Redekop GJ: Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci 2008;35:146-152.
19.
Gottesman RF, Sharma P, Robinson KA, Arnan M, Tsui M, Ladha K, Newman-Toker DE: Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 2012;18:245-254.
20.
Matsukawa H, Shinoda M, Fujii M, Takahashi O, Uemura A, Niimi Y: Basilar extension and posterior inferior cerebellar artery involvement as risk factors for progression of the unruptured spontaneous intradural vertebral artery dissection. J Neurol Neurosurg Psychiatry 2014;85:1049-1054.
21.
de Bray JM, Penisson-Besnier I, Dubas F, Emile J: Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 1997;63:46-51.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.