London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 431 274 Etiology of stroke and risk factors Cerebral ischemia occurring shortly after antiplatelet withdrawal: a prospective study V. Parkhutik1, A. Lago2, J.I. Tembl3, J. Tejada4, D. Geffner5, M.A. Geniz6, J. Marti7, J. Masjuan8, J. Diaz9, B. Fuentes10, I. Casado11, T. Perez12 on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group Department of Neurology, University Hospital la Fe, Valencia, SPAIN1, Department of Neurol-ogy, University Hospital la Fe, Valencia, SPAIN2, Department of Neurology, University Hospital la Fe, Valencia, SPAIN3, Department of Neurology, Hospital of Leon, Leon, SPAIN4, Department of Neurology, General Hospital of Castellon, Castellon, SPAIN5, Department of Neurology, Virgen de la Macarena Hospital, Sevilla, SPAIN6, Department of Neurology, Santa Creu i Sant Pau Hospi-tal, Barcelona, SPAIN7, Stroke Unit, Department of Neurology, Ramon y Cajal Hospital, Madrid, SPAIN8, Department of Neurology, Hospital 12 de Octubre, Madrid, SPAIN9, Department of Neurology, La Paz Hospital, Madrid, SPAIN10, Department of Neurology, San Pedro de Alcántara Hospital, Cáceres, SPAIN11, Department of Internal Medicine. Hospital of Manises, Va-lencia, SPAIN12 Introduction: suspension of antiplatelet drugs has a rebound effect and can therefore be a risk factor for brain ischemia. Our multicentric prospective study included patients with ischemic stroke during the first month after antiplatelet withdrawal. Patient´ characteristics, reasons for withdrawal, timing, type and severity of stroke were analyzed. Patients and methods: 55 patients, mean age 70+/-12 years, 66% men. Thirty two (58%) had previ-ous history of brain ischemia and 14 (25%) of ischemic cardiopathy. Among cases without any of the above, more than half had 3 or more vascular risk factors. Aspirin was the most common drug (36 cases), followed by clopidogrel (12), and double therapy. Mean length of treatment before sus-pension was 40 +/- 35 months. Results: Treatment was stopped by specialists in 62%, patients themselves in 29% and primary phy-sicians in 9%. Valid reasons were major surgery 33%, minor surgery 18%, adverse effects 13%, in-vasive diagnostic procedure 7%. Other reasons included patients being unwilling to take medication (14%), bad understanding of treatment regime (6%), wrongly suspended medication via primary care physician (6%) and problems with pharmaceutical dispensation (2%). Median time since suspension was 7 days (IQR 3-16). Fourteen strokes happened during hospital-ization for the procedure that motivated the suspension. There were 38 strokes (69%) and 17 tran-sient ischemic attacks. By TOAST criteria, large vessel atherosclerosis was responsible for 44% of strokes and further 20% were lacunar. By severity, 50% of strokes were minor with NIH <=4. Modi-fied Rankin score at discharge was <= 3 in 71%. Death rate was 3,6% (2 patients). Conclusion: brain ischemia most frequently occurs approximately 7 days after antiplatelet with-drawal, in patients with previous strokes and high arteriosclerotic risk profile, but its severity tends to be mild (mostly TIA or minor stroke). 275 Etiology of stroke and risk factors Clinical features and outcome of patients with intracranial artery dissections A retrospective single center cohort study T. Sikkema1, M. Uyttenboogaart2, J.M.C. van Dijk3, O. Eshghi4, A. Mazuri5, G.J. Luijckx6 University Medical Center Groningen, Groningen, THE NETHERLANDS1, University Med-ical Center Groningen, Groningen, THE NETHERLANDS2, University Medical Center Gronin-gen, Groningen, THE NETHERLANDS3, University Medical Center Groningen, Groningen, THE NETHERLANDS4, University Medical Center Groningen, Groningen, Groningen, THE NETHER-LANDS5, University Medical Center Groningen, Groningen, THE NETHERLANDS6 Background: Clinical features, functional outcome and survival were evaluated in patients with an intracranial artery dissection (IAD) with emphasis on differences between dissection in the anterior and posterior circulation and between patients presenting with subarachnoid hemorrhage (SAH) or ischemia. Methods: We retrospectively analysed data from 60 patients with an IAD, admitted to our hospital between January 1998 and May 2012. Diagnosis was based on pre-specified angiograph-ic features on MRA, CTA or conventional angiography. Functional outcome was assessed with the modified Rankin scale at latest clinical follow-up. Results: There were 35 women and 25 men (mean age 49.9 years). Eighteen patients had a dissec-tion in the anterior circulation and 42 in the posterior circulation. Mean age was 37.0 in the anterior circulation versus 55.7 years in the posterior circulation group (p = 0.001). SAH occurred in 12 pa-tients with an IAD in the anterior circulation (66.7%) and in 30 in the posterior circulation (71.4%) (p = 0.712). Women presented more often with SAH (66.7% versus 33.3%, p = 0.046). The intra-dural part of the vertebral artery was most frequently affected (33.3%). Mortality was higher in the SAH group (17.1%) versus the non-SAH group (5.6%) (p = 0.414). Favorable outcome was 58.5% in the SAH-group versus 70.6% in the non-SAH group (p = 0.389). Dissections in the anterior circu-lation showed a more favorable outcome (64.7%) compared to the posterior circulation (61%) (p = 0.790). Overall survival was 80% and not significantly different between anterior and posterior cir-culation and in those presenting with SAH or ischemia. Conclusion: Dissections in the posterior circulation and those dissections presenting with SAH showed a worse functional outcome and survival compared to dissections in the anterior circulation and those presenting with ischemia. IAD presenting with SAH had a predilection for the posterior circulation and was more often seen in women.
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