Abstract WP440: Analysis of Hypoplastic Variants of the Circle of Willis in Patients with First-ever Lacunar Stroke

Background: Cerebral small vessel disease is related to widespread endothelial dysfunction, and suspected hypoperfusion at the level of the microcirculation. Lacunar infarcts are a major manifestation of small vessel disease, and result in significant long-term neurological morbidity and mortality. Congenital hypoplastic variants of the vessels of the Circle of Willis may result in impairment of collateral channels at the time of ischemia. Hypothesis: We hypothesized that lateralization of first-ever lacunar infarcts is related to relative hypoperfusion of the ipsilateral hemisphere due to asymmetric hypoplasia of the vessels of the Circle of Willis and inadequate side-to-side collateral circulation. Methods: We analyzed 40 consecutive patients that presented to a stroke center with a first-ever supratentorial lacunar infarct. All patients were able to undergo intracranial vascular imaging. Patients with significant large-vessel disease (even if asymptomatic) were excluded. A neuroradiologist, blinded to ...