ABSTRACT NUMBER: ESOC2026A721 IMAGING SPECTRUM OF ARTERIAL DISSECTION–RELATED ISCHEMIC STROKE: A COMPARATIVE ANALYSIS OF ANTERIOR AND POSTERIOR CIRCULATIONS

Abstract Background and aims Cervical and intracranial arterial dissections are an important cause of ischemic stroke in young and middle-aged adults. Dissection-related strokes arise from a combination of hemodynamic compromise and artery-to-artery embolism, leading to a wide spectrum of infarct patterns and vascular imaging findings. The present study aimed to describe the demographic characteristics, infarct patterns, vascular involvement, and imaging features of arterial dissections involving the anterior and posterior circulations. Methods This was a retrospective observational study conducted at a tertiary care center. Clinical and imaging data were extracted from case records. Imaging features suggestive of dissection—including string sign, target sign, crescent sign, intimal flap, and dissecting aneurysm—were recorded. Patterns of infarcts were recorded. Results A total of 128 patients were included, comprising 70 anterior circulation and 58 posterior circulation cases. The overall mean age was 35.2 ± 11.9 years, with a male predominance (ratio of 2:1). In the anterior circulation cohort, cortical–lobar infarcts were most frequent (65.7%), followed by watershed infarcts, deep(54.3%) and superficial(41.4%). In the posterior circulation cohort, infarcts predominantly involved the brainstem (91.4%) and cerebellum (84.5%). Arterial stenosis was the predominant angiographic abnormality (78.1%). Among dissection-specific imaging signs, the target sign in the anterior circulation (70.0%) and the crescent sign in the posterior circulation (79.3%). An intimal flap was identified in 41 patients overall (32.0%), and a dissecting aneurysm in 19 (14.8%). Conclusions Arterial dissection predominantly affected young adults with a male preponderance. Imaging pattern will help in timely diagnosis and favourable outcomes. Conflict of interest Pritam Raja: nothing to disclose