22. European Stroke Conference 304 Etiology of stroke and risk factors Role of Vertebral Artery Hypoplasia as a risk factor for stroke in lateral medullary infarction H.K. PARK1, S.Y. HA2, K.I. YANG3, D.S. JEONG4, H.G. OH5 Cheonan Hospital, Soonchunhyang University College of Medicine, CHEONAN, SOUTH KO-REA1, Haeundae Paik Hospital, Inje University College of Medicine, BUSAN, SOUTH KOREA2, Cheonan Hospital, Soonchunhyang University College of Medicine, CHEONAN, SOUTH KO-REA3, Cheonan Hospital, Soonchunhyang University College of Medicine, CHEONAN, SOUTH KOREA4, Cheonan Hospital, Soonchunhyang University College of Medicine, CHEONAN, SOUTH KOREA5 Background: Is vertebral artery hypoplasia (VAH) a risk factor for strokes in the posterior cerebral circulation? The aim of our study was to investigate the frequency and clinical relevance of VAH in lateral medullary infarction. Methods: Among 1,568 patients who were admitted due to acute ischemic stroke from September 2007 to December 2011, a total of 40 patients with lateral medullary infarction were selected. The frequency of VAH, defined as a diameter of </= 2.2 mm by contrast-enhanced magnetic resonance angiography, was measured in all patients with lateral medullary infarction. We assessed the risk factors in each patients for stroke. Transcranial Doppler (TCD) was performed in patients with VAH. Stenosis. A stenosis of the distal vertebral artery was diagnosed if the mean flow velocity (MFV) was greater than 55 cm/s. Results: : A total of 13 patients (13/40, 32.5%) had VAH. It was detected in 6 patients (6/21, 28.6%) among the 21 patients in 15-64 years and 7 patients (7/19, 36.8%) among the 19 patients in 65-99 years. In young patients (3 in 15-40 years), all patients had VAH (3/3, 100%) but no additional risk factors for stroke. In very eldery patients (5 in 80-99 years), 3 patients (3/5, 60%) had VAH and ath-erosclerotic risk factors (only hypertension). Although contrast-enhanced MRA showed the narrow-ing of distal vertebral arterty, 13 patients with VAH demonstrated low MFV (20-35 cm/s) in distal symptomatic vertebral artery. Conclusion: The clinical significance of VAH is not yet clearly defined. Some studies postulated that VAH or asymmetry may play a role in posterior circulation ischemia, even in young adults. The VAH, which shows lower mean flow volume and decreased flow velocities, seems to be more sus-ceptible to pro-thrombotic or atherosclerotic processes than normal or dominant vertebral arteries. Vertebral arterial thrombi can cause in situ strokes on lateral medulla and prone to cause distal em-bolization to PICA territory lateral medulla. 446 © 2013 S. Karger AG, Basel Scientific Programme 305 Etiology of stroke and risk factors The relationship between mean platelet volume and severity of acute ischemic brain stroke N.A. Asghari1, F. Ghahremanfard2, H. Ghomi3, S. Afshin4 Fatemiyeh hospital, Tehran, IRAN1, Fatemiyeh hospital, Semnan, IRAN2, Fatemiyeh hospital, Semnan, IRAN3, Fatemiyeh hospital, Semnan, IRAN4 Background: Mean platelet volume (MPV) is considered as a determinant for level of platelet ac-tivity and its role for predicting severe ischemic events has been already conflicting. The present study was performed to determine whether an association exists between MPV and severity of acute ischemic stroke. This study also came to address the power of MPV measurement for discriminat-ing more severe ischemic stroke from mild stroke event. Methods: One hundred consecutive pa-tients with first-ever ischemic stroke presenting to the neurology department of Fatemieh hospital in Semnan between January 2010 and January 2011 were included to this cross-sectional study. Blood samples were taken to measure MPV using an EDTA3K kit and by a Sysmex SE 9000 analyzer. Se-verity of ischemic stroke was assessed by Modified Rankin scale. Results: MPV value was higher and more meaningful in the group with Rankin score ≥ 3 than the subjects with lower scores (9.36 ± 0.95 versus 8.55 ± 0.65, P < 0.001). In parallel, mean platelet count was significantly lower in the former group (238.82 ± 89.22 versus 283.73 ± 89.22, P = 0.020). After controlling risk profile asso-ciated with ischemic stroke in the multivariate logistic regression model, the effect of MPV in isch-emic stroke remained statistically significant (OR: 4.58, 95% Confidence Interval: 1.38 – 15.13, P = 0.012). The area under the ROC curve was 0.77 (95% Confidence Interval: 0.65 – 0.90, P = 0.001), indicating the high discriminative value of MPV for predicting severe ischemic stroke based on Rankin score ≥ 3 from mild stroke situation. Conclusions: MPV is associated with ischemic stroke severity and has a high value for discriminating severe ischemic stroke from its mild situation. TABLE 3: Multivariate regression analysis for determining role of MPV for predicting CVA severity
Karger_ESC London_2013
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