Abstract P715: Vertebral Artery Occlusive Dissection Score in Acute Ischemic Stroke

Abstract

Background and purpose: The discrimination of vertebral artery (VA) occlusive dissection from other etiologies is critical for acute stroke management but sometimes difficult. We aimed to assess the factors associated with VA occlusive dissection and develop the discrimination score. Methods: We examined consecutive patients with acute posterior ischemic stroke due to unilateral VA occlusion from our prospective stroke registry between 2012 and 2019. Unilateral VA occlusion was confirmed by magnetic resonance angiography and cervical ultrasonography. The diagnosis of VA dissection was based on the magnetic resonance imaging or digital subtraction angiography. Dissection score was developed from associated factors to discriminate VA occlusive dissection by logistic regression analysis. Discriminative performance was analyzed by receiver operating curve (ROC) analysis. Results: Consecutive 84 patients (70±13 years; male, 77%) involved 16 (19%) with VA occlusive dissection. On logistic regression analysis, each of younger age ( ≤ 70 years), absence of hypertension, absence of dyslipidemia, head or neck pain, medullary infarction and non-dominance side VA occlusion were significantly associated with VA occlusive dissection (Table). Dissection score was created with these factors by assigning respective points based on the corresponding regression coefficients, and the score were ranged from 0 to 9 (Table). High discriminative performance for VA occlusive dissection was observed (area under the curve: 0.91) and optimal cut-off value was 5 or more (accuracy, 79%; sensitivity, 94%; specificity, 75%). Conclusions: In patients with acute posterior ischemic stroke due to unilateral VA occlusion, dissection score had high discriminative performance for diagnosing VA dissection.