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Long‐term outcome in posterior cerebral artery stroke
Author(s) -
Ntaios G.,
Spengos K.,
Vemmou A. M,
Savvari P.,
Koroboki E.,
Stranjalis G.,
Vemmos K.
Publication year - 2011
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2011.03384.x
Subject(s) - medicine , posterior cerebral artery , stroke (engine) , cardiology , concomitant , infarction , middle cerebral artery , surgery , myocardial infarction , ischemia , mechanical engineering , engineering
Previous studies on posterior cerebral artery (PCA) strokes focused mainly on topography and underlying pathophysiology. However, there are no data on long‐term prognosis and its association with the localization of the infarct. Methods: All consecutive PCA strokes registered in the Athens Stroke Outcome Project between 01/1998 and 12/2009 were included in the analysis. The New England Posterior Circulation Registry criteria were applied to classify them in relation to topography: (i) pure PCA infarcts, including pure cortical‐only and combined cortical/deep PCA infarcts (groups A and B respectively), and (ii) PCA‐plus strokes, including cortical‐only and combined cortical/deep PCA strokes with ≥1 concomitant infarcts outside PCA territory (groups C and D respectively). Patients were prospectively followed up to 10 years after stroke. Results: Amongst 185 (8.1%) PCA patients that were followed up for 49.6 ± 26.7 months, 98 (53%), 24 (13%), 36 (19.5%), and 27 (14.6%) were classified in group A, B, C, and D, respectively. Infections and brain edema with mass effect were more frequently encountered in PCA‐plus strokes compared to pure PCA ( P < 0.05 and <0.01 respectively). At 6 months, 56% of cortical‐only PCA patients had no or minor disability, compared to 37%, 36%, and 26% in the other groups ( P = 0.015). The 10‐year probability of death was 55.1% (95%CI: 42.2–68.0) for pure PCA compared to 72.5% (95%CI: 58.8–86.2) for PCA‐plus (log‐rank 14.2, P = 0.001). Long‐term mortality was associated with initial neurologic severity and underlying stroke mechanism. Conclusions: Patients with pure PCA stroke have significantly lower risk of disability and long‐term mortality compared to PCA strokes with coincident infarction outside the PCA territory.