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Acute stroke patterns in patients with internal carotid artery disease: a diffusion-weighted magnetic resonance
1Department of Neurology, Klinikum Mannheim of the University of Heidelberg, Mannheim, Germany. szabo@neuro.ma.uni-heidelberg.de
Background And Purpose:
Diffusion-weighted (DW) MRI is a sensitive method that facilitates early stroke pattern identification. There are limited data about the influence of stenosis grade on the development of particular stroke patterns in internal carotid artery (ICA) disease. We therefore investigated the lesion patterns on DW MRI in acute stroke patients with ICA disease.
Methods:
DW MRI was analyzed in 102 consecutive acute stroke patients with different degrees of ipsilateral ICA disease. Patients were assigned to 1 of 5 observed lesion patterns: (1) territorial ischemia, (2) subcortical ischemia without or (3) with embolus fragmentation, (4) disseminated lesions in distal cortical regions, and (5) multiple lesions in hemodynamic risk zones. In addition, perfusion-weighted (PW) MRI and MR angiography information was included in the assessment.
Results:
All patterns were observed in the different stages of ICA disease. Half of the patients with high-grade or subtotal stenosis had lesions in hemodynamic risk zones. Territorial stroke occurred in 47.6% of patients with ICA occlusion. Statistical analysis showed a significant relationship between the degree of stenosis and the observed stroke pattern (P=0.001). In 77.8% of patients exhibiting high-grade ICA stenosis, subtotal stenosis, or occlusion, the perfusion lesion was larger than the diffusion lesion (PW/DW mismatch).
Conclusions:
Although in the individual patient any of the infarct patterns may occur, in statistical terms the incidence of a particular stroke pattern is clearly dependent on the degree of stenosis.
Insights
The degree of internal carotid artery (ICA) stenosis significantly influences stroke patterns identified by diffusion-weighted (DW) MRI. Understanding this relationship aids in early stroke diagnosis and management.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Diffusion-weighted (DW) MRI is crucial for early stroke detection.
- Limited data exist on how internal carotid artery (ICA) stenosis grade affects specific stroke patterns.
Purpose of the Study:
- To investigate lesion patterns on DW MRI in acute stroke patients with varying degrees of ICA disease.
- To determine the relationship between ICA stenosis severity and observed stroke patterns.
Main Methods:
- Analyzed DW MRI scans from 102 acute stroke patients with ipsilateral ICA disease.
- Classified lesions into five patterns: territorial, subcortical (with/without embolus fragmentation), disseminated, and hemodynamic risk zones.
- Incorporated perfusion-weighted (PW) MRI and MR angiography data.
Main Results:
- All observed stroke patterns occurred across different ICA stenosis grades.
- High-grade stenosis or occlusion was associated with lesions in hemodynamic risk zones (50% of patients).
- A significant correlation (P=0.001) was found between stenosis degree and stroke pattern; territorial stroke was common in ICA occlusion (47.6%).
- A perfusion-diffusion mismatch (PW/DW mismatch) was noted in 77.8% of patients with high-grade stenosis, subtotal stenosis, or occlusion.
Conclusions:
- While individual stroke patterns can vary, statistical analysis reveals a clear dependence of stroke pattern incidence on the degree of ICA stenosis.
- This finding highlights the importance of assessing stenosis grade in conjunction with DW MRI for stroke pattern characterization.