Artery of Percheron Infarction: Clinical Presentation and Outcomes (P6-5.032)

Abstract

<h3>Objective:</h3> We sought to characterize the presentation, acute treatment, and outcomes in patients with artery of Percheron (AOP) strokes. <h3>Background:</h3> The AOP is an uncommon vascular variant whose occlusion produces bilateral thalamic infarction often resulting in deficits of arousal. <h3>Design/Methods:</h3> We conducted a keyword search of our institution’s neuroimaging database from 2014–2022. All possible cases of AOP infarction were reviewed by two neurologists. We abstracted patient demographics, clinical presentation, acute treatment, acute neuroimaging findings, and laboratory results from the medical record. The median modified Ranking Scale (mRS) and interquartile range (IQR) at baseline, 3 months, and 12 months was analyzed to assess post-AOP stroke disability. Descriptive statistics were used to report clinical findings. <h3>Results:</h3> Our initial search identified 192 potential AOP cases. Fourteen cases of AOP infarction were confirmed and included in our study (8 female [57.1%], median age 67.5 [IQR 60.75–75], median presenting NIHSS 6 [IQR 2–15.25]). Hypertension or systolic blood pressure &gt; 140 (78.5%), decreased level of consciousness (6, 42.8%), and diplopia (6, 42.8%) were the most common presenting complaints. Eleven cases (78.6%) presented to the emergency department (ED). Median time from symptom onset to ED arrival was 14.3 hours (IQR 3.4–63.1); four cases (28.6%) arrived within the conventional thrombolysis time window. Median time from ED arrival to stroke diagnosis was 4.6 hours (IQR 3.8–15.8). Only one patient (7.1%) received IV thrombolysis. Median mRS increased from 2.0 (IQR 0–4) at baseline to 4.0 (IQR 3–5) at 3 months, and 4.0 (IQR 3–4.5) at 12 months. <h3>Conclusions:</h3> Apart from diplopia and hypertension, AOP infarction patients had diverse, non-specific clinical presentations resulting in delayed diagnosis. As a result, despite AOP infarction causing considerable long-term disability, only one patient received IV thrombolysis. Clinicians should maintain a high degree of suspicion for AOP stroke and intervene aggressively in appropriately selected patients. <b>Disclosure:</b> Dr. Ramezani Hashtjin has nothing to disclose. Dr. Ikramuddin has nothing to disclose. Dr. Streib has nothing to disclose.