Clinical Features and Prognosis of Intracranial Artery Dissection

Abstract BACKGROUND: Intracranial artery dissections (IADs) are an important cause of stroke or subarachnoid hemorrhage (SAH). Outcome of IAD in the anterior circulation or presentation without SAH is rarely investigated and might be different. OBJECTIVE: To evaluate the clinical features and prognosis of patients with IAD, with special emphasis on the location (anterior vs posterior circulation) and clinical presentation (SAH or cerebral ischemia). METHODS: Between January 1998 and May 2012, 60 patients with IAD were included in this single-center cohort study. Clinical features, functional outcome, mortality, and prognostic factors were evaluated. Unfavorable functional outcome was defined as a modified Rankin scale score of 3 to 6. RESULTS: In 18 patients (30%), IAD was located in the anterior circulation. At a median follow-up of 6.4 months, 35.3% of patients with IAD in the anterior circulation had an unfavorable functional outcome vs 39.0% in patients with IAD in the posterior circulation (P = .79). Forty-two patients (70%) presented with SAH. Clinical presentation with SAH was not significantly associated with poor functional outcome (41.5% vs 29.4%, P = .39). Low Glasgow Coma Scale score on admission (odds ratio, 0.72, P = .003) and older age (odds ratio, 1.04, P = .04) were independent predictors of unfavorable functional outcome. Mortality rate was 13% and did not significantly differ with location or clinical presentation. CONCLUSION: Low Glasgow Coma Scale score on admission and older age were independent predictors of unfavorable functional outcome. IAD presenting with SAH was not significantly associated with poor functional outcome.

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Complication-Effectiveness Analysis for Unruptured Intracranial Aneurysm Surgery

Neurosurgery ◽

10.1227/neu.0000000000001113 ◽

2015 ◽

Vol 78 (5) ◽

pp. 648-659 ◽

Cited By ~ 10

Author(s):

Michael Kerin Morgan ◽

Markus Wiedmann ◽

Nazih N. Assaad ◽

Gillian Z. Heller

Keyword(s):

Logistic Regression ◽

Effective Treatment ◽

Scale Score ◽

Odds Ratio ◽

Risk Model ◽

Posterior Circulation ◽

Modified Rankin Scale ◽

Anterior Circulation ◽

Complication Risk ◽

Unruptured Intracranial Aneurysms

Abstract BACKGROUND: The aim of intervention for unruptured intracranial aneurysms (UIAs) is safe, effective treatment. OBJECTIVE: To analyze a prospective database for variables influencing the risk of surgery to produce a risk model adjusting this risk for effectively treated aneurysms. METHODS: First, we identified variables to create a model from multiple logistic regression for complications of surgery leading to a 12-month modified Rankin Scale score >1. Second, we established the long-term cumulative incidence of freedom from retreatment or rupture (treated aneurysm) from Kaplan-Meier analysis. Third, we combined these analyses to establish a model of risk of surgery per effective treatment. RESULTS: One thousand twelve patients with 1440 UIA underwent 1080 craniotomies. We found that 10.1% (95% confidence interval [CI], 8.4-12.0) of craniotomies resulted in a complication leading to a modified Rankin Scale score >1 at 12 months. Logistic regression found age (odds ratio, 1.04; 95% CI, 1.02-1.06), size (odds ratio, 1.12; 95% CI, 1.09-1.15), and posterior circulation location (odds ratio, 2.95; 95% CI, 1.82-4.78) to be significant. Cumulative 10-year risk of retreatment or rupture was 3.0% (95% CI, 1.3-7.0). The complication-effectiveness model was derived by dividing the complication risk by the 10-year cumulative freedom from retreatment or rupture proportion. Risk per effective treatment ranged from 1% for a 5-mm anterior circulation UIA in a 20-year-old patient to 70% for a giant posterior circulation UIA in a 70-year-old patient. CONCLUSION: Complication-effectiveness analyses increase the information available with regard to outcome for the management of UIAs.

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Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

Scientific Reports ◽

10.1038/s41598-021-89871-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

H. Handelsmann ◽

L. Herzog ◽

Z. Kulcsar ◽

A. R. Luft ◽

S. Wegener

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Patient Characteristics ◽

Posterior Circulation ◽

University Hospital ◽

Outcome Predictors ◽

Anterior Circulation ◽

Stroke Treatment ◽

The University ◽

Median Admission

AbstractDistinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.

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How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

International Journal of Stroke ◽

10.1177/1747493020985260 ◽

2021 ◽

pp. 174749302098526

Author(s):

Juliane Herm ◽

Ludwig Schlemm ◽

Eberhard Siebert ◽

Georg Bohner ◽

Anna C Alegiani ◽

...

Keyword(s):

Functional Outcome ◽

Odds Ratio ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Stroke Registry ◽

Primary Stroke Center ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

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Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke

PLoS ONE ◽

10.1371/journal.pone.0249093 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0249093

Author(s):

Sabine L. Collette ◽

Maarten Uyttenboogaart ◽

Noor Samuels ◽

Irene C. van der Schaaf ◽

H. Bart van der Worp ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Randomized Clinical Trials ◽

Anesthetic Management ◽

Poor Functional Outcome ◽

Anterior Circulation ◽

Period Increase

Objective The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days. Methods We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds. Results Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35–0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48–1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73–0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78–1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998–1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999–1.000). Conclusions Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects.

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Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp14 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mehdi Bouslama ◽

Ashutosh Jadhav ◽

Diogo C Haussen ◽

Amin Aghaebrahim ◽

Leticia C Rebello ◽

...

Keyword(s):

Confidence Interval ◽

Scale Score ◽

Endovascular Therapy ◽

Odds Ratio ◽

Univariate Analysis ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Patient Specific ◽

Posterior Circulation Stroke ◽

Good Outcome

Background and Purpose: Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke Methods: We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P<0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes. Conclusion: Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.

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Importance of Occlusion Site for Thrombectomy Technique in Stroke

Stroke ◽

10.1161/strokeaha.120.030031 ◽

2021 ◽

Vol 52 (1) ◽

pp. 80-90

Author(s):

Marie Louise E. Bernsen ◽

Robert-Jan B. Goldhoorn ◽

Hester F. Lingsma ◽

Robert J. van Oostenbrugge ◽

Wim H. van Zwam ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Functional Outcome ◽

Cerebral Artery ◽

Odds Ratio ◽

Stent Retriever ◽

Secondary Outcome ◽

Treatment Technique ◽

First Line ◽

Anterior Circulation ◽

Ordinal Logistic Regression Analysis

Background and Purpose: Thrombectomy with stent retriever and direct aspiration are equally effective in the endovascular treatment of anterior circulation acute ischemic stroke. We report efficacy and safety of initial treatment technique per occlusion segment. Methods: For this study, we analyzed data from the MR CLEAN Registry, a prospective, observational study in all centers that perform endovascular therapy in the Netherlands. We used ordinal logistic regression analysis to compare clinical and technical results of first line direct aspiration treatment with that of stent retriever thrombectomy stratified for occlusion segment. Primary outcome measure was functional outcome at 3 months. Secondary outcome measures included reperfusion grade expressed as the extended Thrombolysis in Cerebral Infarction score, periprocedural complication risk, time to reperfusion, and mortality. Results: Of the 2282 included patients, 1658 (73%) were initially treated with stent retriever and 624 (27%) with aspiration. Four hundred sixty-two patients had an occlusion of the intracranial part of the carotid artery, 1349 of the proximal middle cerebral artery, and 471 of the distal parts of the middle cerebral artery. There was no difference in functional outcome between aspiration and stent retriever thrombectomy (odds ratio, 1.0 [95% CI, 0.9–1.2]) in any of the occlusion segments ( P value for interaction=0.2). Reperfusion rate was higher in the aspiration group (odds ratio, 1.4 [95% CI, 1.1–1.6]) and did not differ between occlusion segments ( P value for interaction=0.6). Procedure times were shorter in the aspiration group (minutes 50 versus 65 minutes; P <0.0001). There was no difference in periprocedural complications or mortality. Conclusions: In unselected patients with anterior circulation infarcts, we observed equal functional outcome of aspiration and stent retriever thrombectomy in all occlusion segments. When aspiration was the first line treatment modality, reperfusion rates were higher and procedure times shorter in all occlusion segments.

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Microbleeds, Cerebral Hemorrhage, and Functional Outcome after Endovascular Thrombectomy

Neurology ◽

10.1212/wnl.0000000000011566 ◽

2021 ◽

pp. 10.1212/WNL.0000000000011566

Author(s):

Imad DERRAZ ◽

Federico CAGNAZZO ◽

Nicolas GAILLARD ◽

Riccardo MORGANTI ◽

Cyril DARGAZANLI ◽

...

Keyword(s):

Clinical Outcome ◽

Functional Outcome ◽

Intravenous Thrombolysis ◽

Stroke Severity ◽

Confounding Factors ◽

Poor Functional Outcome ◽

Anterior Circulation ◽

Endovascular Thrombectomy ◽

Poor Outcome ◽

Increased Risk

Objective—To determine whether pre-treatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).Methods—Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin score >2).Results—Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH, in which 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03–1.36 per 1-CMB increase; P=0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, intravenous thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92–1.20 per 1-CMB increase; P=0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, nor presumed pathogenesis was independently correlated with ICH.Conclusions—Poor functional outcome or ICH were not correlated with CMB presence or burden on pre–EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.Classification of Evidence—This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.

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Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000489401 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 221-227 ◽

Cited By ~ 22

Author(s):

Zhenhui Duan ◽

Huaiming Wang ◽

Zhen Wang ◽

Yonggang Hao ◽

Wenjie Zi ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Functional Outcome ◽

Laboratory Data ◽

Poor Functional Outcome ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Relationship

Background and Objective: Endovascular treatment (EVT) is proven to be safe and effective for treating acute large vessel occlusion stroke (LVOS). The neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, which plays an important role in the process of treating ischemic stroke. This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT. Methods: Patients were selected from the EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry. The laboratory data (neutrophil count, lymphocyte count) before EVT were collected. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3–6 at 3 months. Multivariable logistic regression analyses were performed to explore the relationship of NLR with functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality. Results: We eventually included 616 patients (median of age, 66 years; 40.3% female). There were 350 (56.7%) patients achieving mRS of 3–6 at 3 months, 98 (15.9%) patients with sICH, and the mortality at 3 months was 24.8% (153/616). Baseline NLR was independently associated with poor functional outcome (OR 1.58; 95% CI 1.02–2.45; p = 0.039) and sICH (OR 1.84; 95% CI 1.09–3.11; p = 0.023) but showed a trend for predicting 3-month mortality (OR 1.57; 95% CI 0.94–2.65; p = 0.088). Conclusions: NLR independently predicts 3-month functional outcome and sICH but the existence of a trend association with mortality after EVT for acute anterior circulation LVOS patients.

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2B, 2C, or 3

Stroke ◽

10.1161/strokeaha.119.028891 ◽

2020 ◽

Vol 51 (6) ◽

pp. 1790-1796

Author(s):

Natalie E. LeCouffe ◽

Manon Kappelhof ◽

Kilian M. Treurniet ◽

Hester F. Lingsma ◽

Guang Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

The Netherlands ◽

Cerebral Infarction ◽

Endovascular Treatment ◽

Functional Outcome ◽

Odds Ratio ◽

Reference Group ◽

Positive Association ◽

Anterior Circulation ◽

Common Odds Ratio

Background and Purpose— A score of ≥2B on the modified Thrombolysis in Cerebral Infarction scale is generally regarded as successful reperfusion after endovascular treatment for ischemic stroke. The extended Thrombolysis in Cerebral Infarction (eTICI) includes a 2C grade, which indicates near-perfect reperfusion. We investigated how well the respective eTICI scores of 2B, 2C, and 3 correlate with clinical outcome after endovascular treatment. Methods— We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, nationwide registry of endovascular treatment in the Netherlands. We included patients with a proximal intracranial occlusion of the anterior circulation for whom final antero-posterior and lateral digital subtraction angiography imaging was available. Our primary outcome was the distribution on the modified Rankin Scale at 90 days per eTICI grade. We performed (ordinal) logistic regression analyses, using eTICI 2B as reference group, and adjusted for potential confounders. Results— In total, 2807/3637 (77%) patients met the inclusion criteria. Of these, 17% achieved reperfusion grade eTICI 0 to 1, 14% eTICI 2A, 25% eTICI 2B, 12% eTICI 2C, and 32% eTICI 3. Groups differed in terms of age ( P <0.001) and occlusion location ( P <0.01). Procedure times decreased with increasing reperfusion grades. We found a positive association between reperfusion grade and functional outcome, which continued to increase after eTICI 2B (adjusted common odds ratio, 1.22 [95% CI, 0.96–1.57] for eTICI 2C versus 2B; adjusted common odds ratio, 1.33 [95% CI, 1.09–1.62] for eTICI 3 versus 2B). Conclusions— Our results indicate a continuous relationship between reperfusion grade and functional outcome, with eTICI 3 leading to the best outcomes. Although this implies that interventionists should aim for the highest possible reperfusion grade, further research on the optimal strategy is necessary.

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Comparative study of posterior and anterior circulation stroke in childhood

Neurology ◽

10.1212/wnl.0000000000008837 ◽

2019 ◽

Vol 94 (4) ◽

pp. e337-e344 ◽

Cited By ~ 1

Author(s):

Barbara Goeggel Simonetti ◽

Mubeen F. Rafay ◽

Melissa Chung ◽

Warren D. Lo ◽

Lauren A. Beslow ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Presentation ◽

Case Fatality ◽

Posterior Circulation ◽

Stroke Severity ◽

Neurologic Examination ◽

Arterial Ischemic Stroke ◽

Anterior Circulation ◽

Multicenter Observational Study ◽

International Multicenter

ObjectiveTo compare risk factors, clinical presentation, and outcomes after posterior circulation arterial ischemic stroke (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children.MethodsIn this international multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), we compared clinical and radiologic features according to stroke location.ResultsOf 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% vs 22%, p < 0.001). Children with PCAIS were older than children with ACAIS (median age 7.8 [interquartile range (IQR) 3.1–14] vs 5.1 [IQR 1.5–12] years, p < 0.001), and more often presented with headache (54% vs 32%, p < 0.001) and a lower Pediatric NIH Stroke Scale score (4 [IQR 2–8] vs 8 [IQR 3–13], p = 0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% vs 8.5%, p < 0.001), while cardioembolic strokes were less frequent (19% vs 32%, p < 0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurologic examination at hospital discharge in 29% vs 21%, p = 0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates.ConclusionPCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older and have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS.

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