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Association between fetal-type posterior cerebral artery variants and NIHSS-defined stroke severity in acute

Jun He¹, Tao Hao², Wenjuan Li²

¹Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China.

Frontiers in Neurology

|September 16, 2026

Abstract

Objective:

To investigate factors associated with stroke severity among patients with acute posterior circulation infarction (APCI) and to evaluate the association between fetal-type posterior cerebral artery (FTP) variants and NIHSS-defined stroke severity.

Methods:

A retrospective cohort of patients diagnosed with APCI by cranial magnetic resonance imaging (MRI) was selected from the two participating hospitals. The cohort included 161 patients (114 men and 47 women; mean age, 68.12 ± 15.81 years), with a mean admission NIHSS score of 6.28 ± 2.50. Based on magnetic resonance angiography findings, patients were categorized into an FTP group and a non-FTP group. Demographic characteristics, clinical data, and stroke severity as assessed by the National Institutes of Health Stroke Scale (NIHSS) were compared between the two groups. Logistic regression analysis was used to identify factors associated with moderate-to-severe stroke and to evaluate the association between FTP and NIHSS-defined stroke severity.

Results:

Univariate analysis revealed significant differences between the mild and moderate-to-severe groups in fasting blood glucose (5.71 ± 2.06 vs. 7.15 ± 1.74 mmol/L, p = 0.021), uric acid (284.24 ± 85.38 vs. 345.87 ± 86.27 μmol/L, p = 0.019), and prevalence of FTP (p < 0.001). Multivariable analysis showed that FTP was independently associated with moderate-to-severe stroke (adjusted OR = 5.604, 95% CI: 2.519-12.465, p < 0.001). There was a statistically significant difference in NIHSS scores between FTP and non-FTP patients (FTP: 8.55 ± 2.06 vs. non-FTP: 5.14 ± 1.84, p < 0.001).

Conclusion:

Among patients with APCI, FTP was independently associated with greater admission NIHSS-defined stroke severity. FTP may be a potential imaging marker of severity, but the limitations of admission NIHSS in posterior-circulation stroke, unavailable quantitative imaging covariates, and the retrospective design require cautious interpretation and prospective multicenter validation.

Keywords:

associated factors connect fetal-type posterior cerebral artery posterior circulation infarction stroke severity

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