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Karger_ESC London_2013

22. European Stroke Conference 695 Acute stroke: clinical patterns and practice Dynamic changes of the posterior communicating artery in patients with acute basilar artery occlusion S.H. Ahn1, J.S. Kim2 Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, SOUTH KOREA1, Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, SOUTH KOREA2 Background and purpose: Acute basilar artery occlusion (BAO) is associated with poor prognosis and high mortality. Although posterior communicating artery (Pcom) has been considered as important collateral flows in patients with BAO, the role of Pcom in BAO remains uncertain. We sought to investigate the role of Pcom in patients with BAO. Methods: We retrospectively analyzed patients with acute (<72 hr) ischemic stroke who 1) were assessed with diffusion weighted MRI (DWI) 2) had BAO (or >50% of stenosis) on angiogram (mostly MR an-giogram, MRA) and 3) underwent subacute follow-up MRA angiogram. Locations of BAO were classified as proximal (P), middle (M), distal (D) and total (T). Subtypes of Pcom were classified as: (1) “textbook type” (T: with good P1 segment) and (2) ‘fetal type’ (F: with absent P1 segment). In addition, Pcom was further subdivided into (A) “dominant” (d: large Pcom >= 1/2 of P1 diameter) and (B) “minor” (m: small Pcom < 1/2 size of P1). Dynamic changes of Pcom were classified as dis-appeared (D), newly appeared (A) and type-changed (C) patterns after the comparison of initial and follow-up MRAs. Results: In 66 enrolled BAO patients, 41 (62%) had a Pcom (23 “T” type, 15 “F” type and 3 mixed type) and 25 patients (38%) did not. As compared to the latter group, the former group patients more often had cardiogenic embolism (CE) (29.3% vs 4.0%; p<0.01), more distal BAO (73.2% vs 32.0%; p<0.01) and lower prevalence of occipital lesions (17.1% vs 40.0%; p=0.04). On follow-up MRA (mean in-tervals, 4.2 days), 21 patients (32%) showed dynamic changes of Pcom; 15 dynamic changes (D: 9, A: 3, C: 3) were accompanied with recanalization of BAO and 6 changes (A: 5, C: 1) were accom-panied with no recanalization. Minor (“Tm or Fm”) types of Pcom were present 16 of 17 in “D” or “A” pattern of Pcom changes. Conclusions: In patients with BAO, Pcom is associated with lower incidence of occipital lesions and a higher incidence of CE, and shows diverse dynamic changes according to the recanalization of BAO, sug-gesting that Pcom is a dynamic and functionally active rather than static structure. 714 © 2013 S. Karger AG, Basel Scientific Programme Table 1 .Comparison of demographics, vascular risk factors and stroke types between patients with Pcom and patients without Pcom in BAO   Patients with Pcom (n=41) Patients without Pcom (n=25) p-value Age (years), mean±SD 64.8±10.5 66.2±7.80 0.53 Sex (male, %) 25 (61.0) 19 (76.0) 0.21 Risk factors, n (%)       Hypertension 27 (65.9) 16 (64.0) 0.88 Diabetes 9 (22.0) 8 (32.0) 0.37 High CE disease 12 (29.3) 1 (4.0) <0.01* Hyperlipidemia 22 (53.7) 10 (40.0) 0.28 Smoking 14 (29.3) 14 (56.0) 0.08 NIHSS, mean±SD 7.5±7.8 8.3±8.7 0.70 Distal BAO, n (%) 30 (73.2) 8 (32.0) <0.01*  Distal lesion 25(61.0) 6(24.0)    Total lesion 5(12.2) 2(8.0)   Distal ischemic lesion, n (%)       Thalamus 8 (19.5) 4 (16.0) 0.72 Occipital areas 7 (17.1) 10 (40.0) 0.04* CE; cardiogenic embolic, NIHSS; National Institutes of Health Stroke Scale, BAO; basilar artery occlusion Table 2 Patterns of hemodynamic changes of BA and Pcom flows in BAO BAO location Changes of BA flow   Changes of Pcom flow Recan No   D A C 1> Re-can             P 1     1 0 0 M 0     0 0 0 D 13     7 3 3 T 1     1 0 0 2> No             P   1   0 0 1 M   2   0 2 0 D   2   0 2 0 T   1   0 1 0 Total              1> Re-can 15     9 3 3  2> No   6     5 1 BAO; basilar artery occlusion, Pcom; posterior communicating artery, Recan; recanalization of BAO, No; no recanalization of BAO, P; proximal or middle BAO, M; middle BAO, D; distal BAO, T; total BAO D; disappeared of Pcom, A; newly appeared of Pcom, C; changed of types of Pcom   


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