Comparison of Functional Outcomes and Its Association With the Risk Factors in Patients With Anterior and Posterior...

Stroke is a highly debilitating condition resulting in significant morbidity and mortality on a global scale. Anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS) are distinguished by varying risk factors and functional outcomes. This study is designed to identify the disparities in functional outcomes and their association with risk factors in ACIS and PCIS patients, as assessed by the modified Rankin Scale (mRS) at day 90 post-onset of stroke symptoms.

This prospective, observational, comparative study was conducted at the Department of Neurology at Bangladesh Medical University (formerly Bangabandhu Sheikh Mujib Medical University [BSMMU]), Dhaka, over 16 months, from May 2023 to September 2024. A total of 116 ischemic stroke patients (58 in the ACIS group and 58 in the PCIS group) were included in this study. A comprehensive medical history and thorough clinical examinations were performed, along with relevant investigations to assess the risk factors. The functional outcomes of the patients were evaluated using mRS by the principal investigator on day 90.

The mean (±SD) age was 59.0 (±12.50) years in the ACIS group and 58.9 (±15.7) years in the PCIS group; this difference was not statistically significant (p = 0.969). ACIS showed a higher prevalence of cardiac illness (p = 0.002), while hypertension (p = 0.026) and smoking (p = 0.007) were notable in PCIS. The study revealed that patients with PCIS exhibited poorer outcomes in comparison to the ACIS group. Among PCIS patients, 32 (55.2%) had poor outcomes (mRS 3-6), whereas among ACIS patients, 15 (25.9%) did; this difference was statistically significant (p < 0.001). Furthermore, ACIS patients were more likely to experience mortality (8.6% vs. 1.7%). Hypertension was associated with a poor functional outcome in both groups (p = 0.023 for ACIS and p = 0.002 for PCIS patients). In contrast, diabetes mellitus and obesity were associated with a worse functional outcome in ACIS and PCIS patients, respectively (p < 0.001 and p = 0.021).

Patients with PCIS had a higher prevalence of modifiable risk factors like hypertension and smoking, and showed significantly poorer functional outcomes than those with ACIS at 90 days. Additionally, higher frequencies of cardiac illness and mortality were notable in ACIS. These study findings will help clinicians to plan for specific prevention, acute management, and rehabilitation of Bangladeshi stroke patients.