Abstract Details

Title The Vascular Topography of Ischemic Stroke in Young Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 226

Objective

Background BACKGROUND: The underlying mechanisms of stroke in young populations differ from those of older adults. Understanding the relationship between stroke topography and mechanism may improve our understanding of the spectrum of cerebrovascular disease in young adults.

Design/Methods DESIGN/METHODS: The charts of patients 15-49 years of age presenting to Boston Medical Center with a diagnosis of IS between 1/2006 and 2/2010 were reviewed. Eligible patients had acute/subacute IS, vascular topography rated on DWI/MRI or CT scan obtained during admission, and stroke mechanism listed as small vessel disease (SVD, n=24), large vessel disease (LVD, n=25), cardioembolic (n=21), or undetermined (n=19). Stroke mechanisms were compared with imaging topography.

Results RESULTS: Among 105 patients, 79 were eligible with mean age 42±7.1, 63%M, 60% Black/Hispanic. The anterior circulation (AC) was involved in 55%, posterior circulation (PC) in 49%, and multiple vascular (MV) territories in 6%. Strokes occurred most frequently in MCA (49%), PCA (32%) and PICA (12%) territories. The perforating arteries were involved in 45% of events. SVD was more often the mechanism underlying PC strokes compared to AC strokes (45% vs. 11%,p<0.01). LVD/CE were more common in AC strokes (30% vs 16%,p<0.01). PCA strokes had more proximal vascular stenosis >50% compared to MCA strokes (77% vs. 62%,p<0.05). Patients with IS in the territory of perforating arteries were less likely to have proximal vascular stenosis>50% (19% vs. 51%,p<0.01) or cardioembolism (11% vs. 37%,p<0.01) compared to the other vascular territories.

Conclusions CONCLUSIONS: Our preliminary findings suggest that IS in the young occurs most frequently in the AC, with significant differences between the underlying mechanisms of AC and PC strokes, as well as strokes limited to perforating artery territories. The presenting vascular topography may help guide clinicians to the prompt diagnosis of stroke mechanism in young populations.

Authors/Disclosures
Melissa L. Rayhill, MD, FAAN (UBMD Neurology/University At Buffalo SUNY) PRESENTER	Dr. Rayhill has received personal compensation in the range of $500-$4,999 for serving as a Presenter with Headache Cooperative of New England. Dr. Rayhill has received personal compensation in the range of $500-$4,999 for serving as a Presenter with Clusterbusters. Dr. Rayhill has received personal compensation in the range of $500-$4,999 for serving as a Presenter with ��ɫ��.
Christopher H. Gibbons, MD, FAAN (Beth Israel Deaconess Medical Center)	Dr. Gibbons has received personal compensation for serving as an employee of CND Life Sciences. Dr. Gibbons has or had stock in CND Life Sciences.Dr. Gibbons has received publishing royalties from a publication relating to health care.
Ashkan Shoamanesh, MD	Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer AG. Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo . Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Servier Inc.. Dr. Shoamanesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurodiem.ca. The institution of Dr. Shoamanesh has received research support from Servier Canada Inc.. The institution of Dr. Shoamanesh has received research support from Daiichi Sankyo Ltd.. The institution of Dr. Shoamanesh has received research support from Bayer AG. The institution of Dr. Shoamanesh has received research support from Bristol-Myers Squibb. The institution of Dr. Shoamanesh has received research support from Octapharma Canada .
Luciana Catanese, MD	Dr. Catanese has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for IschemiaCare.
Helena W. Lau	No disclosure on file
Jose R. Romero, MD (Boston University School of Medicine - Boston Medical Center)	The institution of Dr. Romero has received research support from NIH/NIA.
Howard Feldman, MD, FAAN (University of California San Diego)	The institution of Dr. Feldman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. The institution of Dr. Feldman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen Research & Development LLC. The institution of Dr. Feldman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tau Consortium. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from Vivoryon Therapeutics. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from US National Institute of Health NIH/NIA. The institution of Dr. Feldman has received research support from Allyx Pharmaceuticals. The institution of Dr. Feldman has received research support from Canadian Institutes of Health Research . Dr. Feldman has received intellectual property interests from a discovery or technology relating to health care. Dr. Feldman has a non-compensated relationship as a Medical Advisory Council with Association for Frontotemporal Degeneration (AFTD) that is relevant to AAN interests or activities. Dr. Feldman has a non-compensated relationship as a International Scientific Advisory Board with Translating Research in Elder Care (TREC) that is relevant to AAN interests or activities. Dr. Feldman has a non-compensated relationship as a Conference, Presenter with Royal Society of Canada that is relevant to AAN interests or activities. Dr. Feldman has a non-compensated relationship as a Conference, Presenter with Banner Health that is relevant to AAN interests or activities. Dr. Feldman has a non-compensated relationship as a Conference, Presenter, Manuscript Author with University of British Columbia that is relevant to AAN interests or activities.
Viken L. Babikian, MD, FAAN	Dr. Babikian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Babikian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Baim Institute for Clinical Research. Dr. Babikian has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific.
Carlos S. Kase, MD, FAHA, FAAN	Dr. Kase has nothing to disclose.
Aleksandra Pikula, MD	The institution of Dr. Pikula has received research support from CIHR.

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