Clinical characteristics, Risk factors, and outcomes of Posterior circulation stroke: A retrospective study between younger and older adults in Saudi Arabia

Introduction Posterior circulation stroke (PCS) may be less prevalent than its anterior counterpart but contributes to substantial morbidity and mortality. The aim was to characterize PCS's demographics, clinical presentation, management, and outcomes between younger and older adults in Saudi Arabia. Methods This retrospective cohort study was conducted at two tertiary medical centers in Saudi Arabia between March 2016 and December 2020. All patients who presented with symptoms of posterior circulation stroke and had positive brain imaging were included. Results The study involved 160 posterior circulation stroke patients, stratified into two age groups: 71 patients aged 18-59 years and 89 patients aged 60 years and above. The mean age of the entire cohort was 60.9 years, and 77% were males. Hypertension was more prevalent in the older age group (88% vs. 69%, p=0.005), and smoking was significantly higher among younger patients (38% vs. 15%; p=0.0009). Only 22.4% received thrombolysis and/or thrombectomy. Most strokes involved the posterior cerebral artery (45.6%). Large artery atherosclerosis was the most common subtype. At discharge, younger patients had higher NIHSS compared to older patients. Conclusion Our investigation of 160 posterior circulation stroke (PCS) patients in Saudi Arabia uncovers notable trends: a mere 22.4% received thrombolysis and/or thrombectomy and a significant prevalence of posterior cerebral artery involvement due to large artery atherosclerosis. The study further reveals younger patients disproportionately had severe outcomes. Highlighting the need for improved stroke care and heightened awareness, this research contributes vital data to an underexplored domain, urging further study to optimize care and understand PCS dynamics in Saudi Arabia.