Abstract Details

Title Absent A1 Segment - How Does It Impact Ischemic Stroke Characteristics and Outcome?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 186

Objective

Background BACKGROUND: Previous studies have shown that anatomical variants of the cerebral arterial circle are common, particularly in the anterior circulation. Absence of the A1 segment can compromise anterior cerebral collateral blood flow. Few studies have examined the association of an absent A1 segment and ischemic stroke outcome.

Design/Methods DESIGN/METHODS: A retrospective review of prospectively identified patients with AIS from 7/2008-12/2010 was performed. Patients without intracranial vascular imaging were excluded. We compared patients with absent A1 to patients with bilateral A1's present in terms of demographics, stroke severity (as measured by NIHSS), vascular distribution, and in-hospital mortality using Chi-square tests and logistic regression.

Results RESULTS: Of the 536 patients with AIS and intracranial vascular imaging, 4% (n=23) had absent A1. Compared with other AIS patients, those with absent A1 had no significant difference in demographics, baseline NIHSS or discharge NIHSS. Patients with Absent A1 more frequently reported prior stroke (59% vs. 39%; p=0.058). There was no significant difference in vessel involvement, length of stay, or functional outcome, as measured by mRS at discharge. Patients with an absent A1 had nearly 5 times higher odds of in-hospital mortality (OR 4.6, 95% CI 1.6-13.3, p=0.005). The increased odds of inpatient mortality seen in patients with an absent A1 remained significant even after adjusting for age, NIHSS at presentation, glucose on admission, and history of prior stroke (OR 4.3, 95% CI 1.2-15.6, p=0.026).

Conclusions CONCLUSIONS: Based on our results, patients with an absent A1 segment reported higher rates of prior stroke. Despite adjusting for this difference, patients with absent A1 had higher inpatient mortality. Further studies are required to confirm these findings and to determine the reasons of increased mortality among patients with absent A1.

Authors/Disclosures
Amir Shaban, MD (University of Iowa) PRESENTER	Dr. Shaban has nothing to disclose.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
	No disclosure on file
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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