Posterior Circulation Stroke Epidemiology and Management

Posterior circulation strokes account for approximately 20–25% of all ischaemic strokes, arising from occlusion within the vertebrobasilar arterial system. This vascular territory supplies the brainstem, cerebellum and occipital lobes, and small infarcts may present with subtle symptoms such as vertigo, diplopia or ataxia. Global incidence varies by region, with increasing prevalence in ageing populations and areas with high burdens of hypertension and diabetes. Diagnostic complexity arises from non-specific clinical features and the relative insensitivity of early non-contrast CT in the posterior fossa. Management strategies encompass acute reperfusion through intravenous thrombolysis and endovascular thrombectomy, supported by advanced imaging techniques including CT perfusion and diffusion-weighted MRI to delineate salvageable tissue. Time-to-treatment remains a critical determinant of outcome, yet posterior circulation events often experience prehospital and in-hospital delays. Long-term secondary prevention focuses on optimal control of vascular risk factors and antithrombotic therapy. Emerging research highlights the need for refined triage protocols, tailored therapeutic thresholds for brainstem infarction and improved clinical scales to capture posterior circulation signs. Collectively, these developments aim to reduce morbidity and mortality by enhancing early recognition, expanding access to reperfusion therapies and standardising outcomes assessment.

Research from Nature Portfolio

Recent registry analyses have clarified that vascular territory alone does not predict three-month outcomes in ischaemic stroke. Large-scale data demonstrate that baseline severity, as measured by the National Institutes of Health Stroke Scale, exerts a dose–response effect on mortality and functional independence, outweighing the influence of posterior versus anterior circulation involvement. Age and diabetes further modify risks, but the most significant predictor remains initial neurological deficit. These insights have informed clinical practice by emphasising early severity stratification and supporting the universal application of reperfusion protocols regardless of territory.

Posterior Circulation Stroke Epidemiology and Management publication trend

The graph below shows the total number of articles in posterior circulation stroke epidemiology and management across all publications each year (not limited to Nature Index journals).

Technical terms

Posterior circulation stroke: Infarction occurring in the vertebrobasilar arterial system supplying the brainstem, cerebellum and occipital lobes.

Vertebrobasilar arterial system: Network of vessels including the vertebral and basilar arteries that perfuse the posterior brain structures.

Intravenous thrombolysis: Administration of clot-dissolving medication via a vein to restore blood flow in an acute ischaemic stroke.

Large vessel occlusion: Blockage of a major intracranial artery, often amenable to endovascular thrombectomy.

National Institutes of Health Stroke Scale (NIHSS): Standardised tool for quantifying initial stroke severity and guiding management decisions.

References

1. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management. Frontiers in Neurology (2014).
2. Prehospital and intra-hospital time delays in posterior circulation stroke: results from the Austrian Stroke Unit Registry. Journal of Neurology (2016).
3. Multimodal Computed Tomography Increases the Detection of Posterior Fossa Strokes Compared to Brain Non-contrast Computed Tomography. Frontiers in Neurology (2020).
4. Pitfalls in the Diagnosis of Posterior Circulation Stroke in the Emergency Setting. Frontiers in Neurology (2021).
5. Outcome predictors in anterior and posterior ischemic strokes: a study based on the Iranian SITS registry. Scientific Reports (2023).
6. Intravenous Thrombolysis in Posterior versus Anterior Circulation Stroke: Clinical Outcome Differs Only in Patients with Large Vessel Occlusion. Biomedicines (2024).