Frontiers in neurology · 2026
Proportions, trends, and outcomes of posterior circulation ischemic stroke in the United States.
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Qureshi Adnan I, Jayaraj Ranjini Nived, Cohen David, Spall Shahhan, Roy Akash, Cassarly Christy N, Martin Renee H, Powers William J, Kwok Chun Shing
Аннотация
BACKGROUND: Posterior circulation ischemic stroke has been previously studied in single-center and multicenter registries. The contemporary proportions, trends, and outcomes of posterior circulation ischemic stroke at a national level are not known.
METHODS: We identified patients admitted with ischemic stroke using the Nationwide Inpatient Sample from 2016 to 2022. We compared the rates of intravenous (IV) thrombolysis, thrombectomy, in-hospital mortality, routine discharge without palliative care (based on discharge disposition), and length and costs of hospitalization in patients admitted with posterior circulation ischemic stroke to patients admitted with anterior circulation ischemic stroke.
RESULTS: Among 4,773,715 ischemic stroke admissions, 1,675,030 (35.1%) had a territory-specific localization code and 1,630,520 were included for analysis. A total of 383,990 (23.6%) and 1,246,530 (76.4%) patients were admitted with posterior and anterior circulation ischemic stroke, respectively. From 2016 to 2022, the number of patients admitted with posterior circulation ischemic strokes increased from 42,055 in 2016 to 73,755 in 2022, demonstrating a temporal trend (p trend p < 0.001). Patients with posterior circulation ischemic stroke were more likely to have diabetes mellitus and less likely to have heart failure and atrial fibrillation. The proportion of patients with a National Institutes of Health Stroke Scale (NIHSS) score of 0-4 was significantly higher in patients with posterior circulation ischemic stroke (63.8% vs. 40.8%). The utilization of IV thrombolysis (6.1% vs. 13.3%) and thrombectomy (4.0% vs. 16.4%) was lower in patients with posterior circulation ischemic stroke compared with those with anterior circulation ischemic stroke. The in-hospital mortality was significantly higher [odds ratio 1.53, 95% CI: (1.45-1.63), p < 0.001] in patients with posterior circulation ischemic stroke after adjusting for potential confounders, including NIHSS score strata.
CONCLUSIONS: Over 20% of acute ischemic strokes occur in posterior circulation territories in the United States. Patients with posterior circulation ischemic stroke are less likely to receive acute stroke treatment compared with those with anterior circulation ischemic stroke.
METHODS: We identified patients admitted with ischemic stroke using the Nationwide Inpatient Sample from 2016 to 2022. We compared the rates of intravenous (IV) thrombolysis, thrombectomy, in-hospital mortality, routine discharge without palliative care (based on discharge disposition), and length and costs of hospitalization in patients admitted with posterior circulation ischemic stroke to patients admitted with anterior circulation ischemic stroke.
RESULTS: Among 4,773,715 ischemic stroke admissions, 1,675,030 (35.1%) had a territory-specific localization code and 1,630,520 were included for analysis. A total of 383,990 (23.6%) and 1,246,530 (76.4%) patients were admitted with posterior and anterior circulation ischemic stroke, respectively. From 2016 to 2022, the number of patients admitted with posterior circulation ischemic strokes increased from 42,055 in 2016 to 73,755 in 2022, demonstrating a temporal trend (p trend p < 0.001). Patients with posterior circulation ischemic stroke were more likely to have diabetes mellitus and less likely to have heart failure and atrial fibrillation. The proportion of patients with a National Institutes of Health Stroke Scale (NIHSS) score of 0-4 was significantly higher in patients with posterior circulation ischemic stroke (63.8% vs. 40.8%). The utilization of IV thrombolysis (6.1% vs. 13.3%) and thrombectomy (4.0% vs. 16.4%) was lower in patients with posterior circulation ischemic stroke compared with those with anterior circulation ischemic stroke. The in-hospital mortality was significantly higher [odds ratio 1.53, 95% CI: (1.45-1.63), p < 0.001] in patients with posterior circulation ischemic stroke after adjusting for potential confounders, including NIHSS score strata.
CONCLUSIONS: Over 20% of acute ischemic strokes occur in posterior circulation territories in the United States. Patients with posterior circulation ischemic stroke are less likely to receive acute stroke treatment compared with those with anterior circulation ischemic stroke.