Distinct Risk Profiles in Posterior vs Anterior Circulation Strokes: A Prospective Study from Western India

Anterior (ACS) and posterior circulation strokes (PCS) differ in clinical presentation, vascular pathology, and associated risk factors.

The aim of the study was to compare vascular risk profiles, clinical characteristics, neuroimaging findings, and outcomes between ACS and PCS patients in a hospital-based cohort.

A prospective observational study was conducted at a tertiary care hospital, from January to December 2021. Consecutive patients with confirmed anterior or posterior circulation stroke were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) scores, vascular risk factors (hypertension, diabetes, dyslipidemia, smoking, metabolic syndrome), presenting symptoms, computed tomography (CT) imaging findings, and outcomes [modified Rankin Scale (mRS) at discharge, mortality] were recorded. Univariate and multivariate logistic regression analyses were performed.

Among 376 stroke patients analyzed, 274 (72.9%) had ACS and 102 (27.1%) had PCS. PCS patients were significantly younger (54.6 vs 61.2 years; p = 0.003), with a higher prevalence of hypertension (78.4 vs 62.8%; p = 0.008), current smoking (45.1 vs 28.8%; p = 0.002), metabolic syndrome (41.2 vs 28.5%; p = 0.02), and poor glycemic control (HbA1c >8% in 51.2 vs 38.6%; p = 0.04). PCS presented more often with vertigo (78.4%), ataxia (62.7%), and visual symptoms (54.9%), while ACS typically presented with hemiparesis and aphasia. Despite lower NIHSS scores, brainstem infarcts in PCS accounted for most in-hospital deaths. Multivariate analysis identified hypertension, smoking, age <55, and metabolic syndrome as independent predictors of PCS.

PCS affect a younger demographic and are independently associated with modifiable metabolic and vascular risk factors. Their atypical presentation and distinct risk profile call for targeted screening and prevention strategies, particularly in younger Indian adults.