INTRODUCTION: Early neurological deterioration (END) is a common problem of stroke practice. Although lacunar
pontine infarcts are known with the high risk of END, such worsening can also be seen in patients with pontine infarcts
attributed to basilar artery stenosis. Since the quality of collateral supply are considered one of the proposed mechanisms
of END, we hypothesized that the pattern of posterior communicating arteries (PcoA) would be associated with END in
pontine infarcts with basilar artery stenosis.
METHODS: Patients with acute pontine infarcts and having ≥50 basilar artery stenosis were included in the study. END
was diagnosed as an increase of at least 2 points on the National Institutes of Health Stroke Scale from baseline during the
5 days. A diagnosis of PcoA hypoplasia was based on the presence of either a PcoA of less than 1 mm in diameter or the
absence of a PcoA, based on computed tomography angiography (CTA). Univariate and multivariate analysis were
performed to compare demographics, risk factors and the hypoplasi of PcoA between patients with END and those without
RESULTS: Of 60 patients included, 17 patients (28.3%) exhibited END. Demographics and vascular risk factors did not
differ between groups. END was significantly higher in patients having at least one hypoplastic PcoA and those with
bilateral PcoA hypoplasia as compared to patients without hypoplasia (p=0.040, p=0.006, respectively). In multivariate
analysis, there was a trend for the development of END in patients with bilateral hypoplastic PcoA (β =1.9, 95% CI 0.8-59;
DISCUSSION and CONCLUSION: Bilateral hypoplasia of PcoA might be associated with the development of END in pontine
infarcts attributed to basilar arteries.
Keywords: Pontine infarct, basilar artery stenosis, early neurological deterioration, posterior communicating artery..