Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

Research output: Contribution to journalArticle


Objective: Posterior circulation ischemic stroke (PCiS) constitutes 20–30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. 

Methods: Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. 

Results: PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04–1.61; male sex, OR = 1.46; 95% CI 1.21–1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. 

Conclusion: Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.


  • Petrea Frid
  • Mattias Drake
  • A. K. Giese
  • J. Wasselius
  • M. D. Schirmer
  • K. L. Donahue
  • L. Cloonan
  • R. Irie
  • M. J.R.J. Bouts
  • E. C. McIntosh
  • S. J.T. Mocking
  • A. V. Dalca
  • R. Sridharan
  • H. Xu
  • E. Giralt-Steinhauer
  • Lukas Holmegaard
  • Katarina Jood
  • J. Roquer
  • John W Cole
  • P. F. McArdle
  • J. P. Broderick
  • J. Jimenez-Conde
  • Christina Jern
  • B. M. Kissela
  • D. O. Kleindorfer
  • Robin Lemmens
  • J. F. Meschia
  • Tatjana Rundek
  • R. L. Sacco
  • R. Schmidt
  • Pankaj Sharma
  • A. Slowik
  • V. Thijs
  • D. Woo
  • B. B. Worrall
  • Steven J. Kittner
  • B. D. Mitchell
  • J. Petersson
  • Jonathan Rosand
  • P. Golland
  • Ona Wu
  • N. S. Rost
  • A. Lindgren
  • NINDS Stroke Genetics Network (SiGN)
  • International Stroke Genetics Consortium
  • the MRI-Genetics Interface Exploration (MRI-GENIE)
External organisations
  • Skåne University Hospital
  • Massachusetts General Hospital
  • Broad Institute
  • Massachusetts Institute of Technology
  • German Center for Neurodegenerative Diseases (DZNE), Bonn
  • University of Maryland School of Medicine
  • Autonomous University of Barcelona
  • Sahlgrenska Academy
  • Sahlgrenska University Hospital
  • Baltimore Veterans Administration Medical Center
  • University of Cincinnati College of Medicine
  • University of Gothenburg
  • Catholic University of Leuven
  • University Hospitals Leuven
  • Mayo Clinic Florida
  • University of Miami
  • Medical University of Graz
  • Royal Holloway University of London
  • Jagellonian University
  • Austin Health
  • University of Virginia
  • Harvard Medical School
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology


  • Magnetic resonance imaging, Phenotyping, Posterior circulation brain infarction, Risk factors, Stroke
Original languageEnglish
Pages (from-to)649-658
Number of pages10
JournalJournal of Neurology
Issue number3
Early online date2019 Nov 11
Publication statusPublished - 2020 Mar
Publication categoryResearch

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