ABSTRACT NUMBER: ESOC2026A481 CHARACTERISTICS OF SINGLE VS MULTIPLE ACUTE INFARCTS IN THE PERFORATING ARTERY TERRITORY

Abstract Background and aims This study aimed to clarify the clinical characteristics that distinguish multiple acute perforating artery infarctions from single infarctions. Methods We identified 834 patients with acute ischemic stroke confined to perforating artery territories. Patients were classified into multiple (n = 134) and single infarction groups (n = 700). Demographics, vascular risk factors, admission data, and laboratory findings were compared between the two groups. Results Patients with multiple infarctions were older (74.5 ± 12.3 vs. 70.8 ± 12.5 years, p = 0.0015) and had higher admission NIHSS scores (median 4 vs. 3, p < 0.001) than those with single lesions. The single group had higher diastolic blood pressure (91.0 ± 18.4 vs. 86.1 ± 16.8 mmHg, p = 0.0042) and more frequent dyslipidemia (46.0% vs. 32.8%, p = 0.0049). No significant differences were observed in diabetes, chronic kidney disease, coronary artery disease, heart failure, or smoking history. D-dimer (median 1.0 vs. 0.7 μg/mL, p < 0.001) and BNP (median 35.1 vs. 23.8 pg/mL, p < 0.001) levels were higher in the multiple group, as were atrial fibrillation (20.9% vs. 13.4%, p = 0.025) and major artery lesions (35.8% vs. 12.9%, p < 0.0001). Conclusions Among patients with acute ischemic stroke confined to perforating artery territories, 16% have multiple infarctions. Multiple infarctions were associated with embolic sources, including atrial fibrillation and major artery lesions, suggesting that embolic stroke should be considered in addition to the small vessel occlusion even when infarctions are confined exclusively to perforating artery territories. Conflict of interest All of author: nothing to disclose