Abstract T P88: Angiographic Steno-Occlusive Lesion and Collateral Circulation in Cerebral Vascular Reservoir in Acute Ischemic Stroke and Transent Ischemic Attack

Abstract

Background: : Atherosclerotic intra- or extra- cranial steno-occlusive disease is one of the risk factors of ischemic stroke. While best medial treatment, some patients with these lesions still have hypoperfusion and may need an intervention for proper perfusion. In the real world of clinical practice, it is difficult to perform all kinds of studies such as digital subtraction angiography (DSA), MR perfusion, SPECT with Diamox challenig for assessment of perfusion status and cerebral vascular reservoir (CVR). We selected patients who undergone those methods and evaluated the correlations beween the collateral pattern and perfusion status and clinical manifestation and short term outcome. Methods: From a cohort of patients consecutively admitted for stroke or transient ischemic attack (TIA), we selected patients with symptomatic large artery steno-occlusive lesion confirmed by DSA. Cerebral angiogram was graded systematically in a blinded fashion for collateral flow, using Theraupeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading. We also evaluated diffusion-perfusion mismatch in MRI studies and CVR by Diamox SPECT. Demographic and clnical variables, initial NIHSS score and modified Rankin scale (mRS) scores at discharge were collcted. We divided thse patients in two groups according to cerebral vascalar reservoir pattern and compared clnical and imaging status. Results: A total of 21 patient were selected. Men was 14(67%) and mean age was 64.3(range of 40 to 84). Eleven patients had ICA steno-occlusive (7 with occlusion), 8 had MCA steno-occlusive lesions(4 with occlusion) and remaning 2 had tandem lesions. In Diamox SPECT, 6 patients showed preserved CVR. Patients with preserved CVR more had stenotic lesion while those with reduced CVR had occlusive lesion (p=0.001) and ASITN/SIR grading was differently distributed between two groups (p=0.046). Conclusion: DSA is still most important in evaluating steno-occlusive lesion and collateral status as shown previous studies. The status of the steno-occlusive lesion may have an effect on CVR. And the pattern of collateral flows may have a certain relation to vascular reserve capacity. But there are needed longer follow up in much larger populations.