Abstract 159: Posterior Communicating Artery Flow Diversion in Middle Cerebral Artery Stroke: Angiographic Evidence from IMS III
Background: Only 20% of adults have a “fetal” posterior communicating artery (PCOMM) with carotid flow to the posterior cerebral artery. Dynamic pressure changes at the circle of Willis due to proximal artery occlusion may restore such collateral blood flow patterns. We investigated the findings and implications of PCOMM blood flow in middle cerebral artery (MCA) stroke at angiography in IMS III.
Methods: The angiography core lab prospectively evaluated PCOMM blood flow and collateral circulation in proximal MCA or M1 occlusion. Proximal or distal M1 occlusion was noted with PCOMM flow scored (0-2) on ipsilateral carotid injections before and after endovascular therapy, correlating PCOMM status with ASITN/SIR leptomeningeal collateral grade, TICI reperfusion and subsequent clinical outcomes.
Results: 122 patients with M1 occlusion at angiography (60 proximal, 62 distal) had peri-procedural evaluation of PCOMM status and associated collateral grade. Ipsilateral carotid injections revealed PCOMM flow diversion in 87/122 (71%) prior to revascularization, including 41/60 (68%) in proximal M1 and 46/62 (74%) in distal M1 (p=0.61) occlusions. After treatment, PCOMM patency was noted in 86/122 (71%), with 40/60 (67%) in proximal M1 and 46/62 (74%) in distal M1 (p=0.48) occlusions. Decrease in PCOMM score after therapy was noted in 11/122 (9%); 9/11 (82%) had mTICI 2B-3 reperfusion compared to 48/111 (43%) mTICI 2B-3 reperfusion in those with PCOMM unchanged (p=0.03). PCOMM flow (n=85) was associated with worse ASITN/SIR collaterals (median 2, IQR 2-3) than those without (n=29; median 3, IQR 2-3), p=0.09. PCOMM patency before treatment had 90-day mRS median of 4 (2-6) versus 3 (1-4), p=0.37.
Conclusions: PCOMM flow diversion is common in MCA stroke, revealing an inverse correlation with leptomeningeal collaterals and dynamic changes following reperfusion.
Author Disclosures: D.S. Liebeskind: Consultant/Advisory Board; Modest; Medtronic, Stryker. Research Grant; Significant; NIH-NINDS. A.M. Demchuk: Research Grant; Significant; NIH. Consultant/Advisory Board; Modest; Medtronic. T.G. Jovin: Research Grant; Modest; Fundacio Ictus Malaltia Vascular , PI REVASCAT unpaid. Honoraria; Modest; Neuravi, Steering Committe Member, J&J DSMB Member. Consultant/Advisory Board; Modest; Stryker neurovascular, PI DAWN unpaid, Medtronic, SWIFT PRIME Steering Committe unpaid. Research Grant; Significant; No. Honoraria; Significant; No, NO. Consultant/Advisory Board; Significant; NO. B.K. Menon: Research Grant; Significant; CIHR. R.G. Nogueira: Consultant/Advisory Board; Modest; Stryker, Medtronic, Penumbra. O.O. Zaidat: Consultant/Advisory Board; Modest; Penumbra, Stryker, Medtronic. F. Scalzo: None. M.D. Hill: Consultant/Advisory Board; Modest; Adjudication panel for Merck for a clinical trials outcomes panel.. Research Grant; Significant; Research grant to the University of Calgary from Covidien AG for the ESCAPE trial. Other Research Support; Significant; Drug in kind support for the TEMPO-1 trial from Hoffmann-La Roche Canada Ltd. Ownership Interest; Significant; Calgary Scientific Inc.. J. Carrozzella: None. R. von Kummer: Consultant/Advisory Board; Modest; Karolinska Institutet, Brainsgate, Medtronic, Penumbra. P. Khatri: Honoraria; Modest; UpToDate,Inc (online publication). Expert Witness; Modest; Medicolegal consultation. Consultant/Advisory Board; Modest; Grand Rounds, Inc (online clinical consultation). Research Grant; Significant; NIH/NINDS. Other Research Support; Significant; Genentech (pays dept for effort as PI of PRISMS trial), Penumbra (pays dept for effort as Neuro PI of THERAPY trial). M. Goyal: Research Grant; Significant; Funding from Covidien for design and conduct of SWIFT PRIME trial. Part funding of ESCAPE trial from Covidien provided to Univ of Calgary. Speakers' Bureau; Significant; For teaching engagements from Covidien and Stryker. B. Yan: Research Grant; Significant; Codman. Consultant/Advisory Board; Modest; Stryker, Bio CSL, Ingelheim Boerhinger. Other; Modest; Bayer. L.D. Foster: None. S.D. Yeatts: None. Y.Y. Palesch: Consultant/Advisory Board; Modest; Brainsgate. J.P. Broderick: Consultant/Advisory Board; Modest; Genentech. T.A. Tomsick: None. A.J. Yoo: Consultant/Advisory Board; Modest; Neuravi. Consultant/Advisory Board; Significant; Penumbra.
- © 2016 by American Heart Association, Inc.