[Mechanisms involved in large subcortical infarcts]

Area of Science:

• Neurology
• Vascular Neurology
• Stroke Pathogenesis

Context:

• Large subcortical infarcts (LSI) are a significant subtype of ischemic stroke.
• Previous investigations have not systematically analyzed the stroke mechanisms underlying LSIs.
• Understanding the specific causes of LSIs is crucial for targeted prevention and treatment.

Purpose:

• To systematically investigate and clarify the stroke mechanisms involved in large subcortical infarcts.
• To differentiate stroke pathogenesis between infarcts in the lenticulostriate artery territory and the internal borderzone.

Summary:

• This study analyzed 50 patients with large subcortical infarcts, categorizing them into lenticulostriate artery (n=39) and internal borderzone (n=11) groups.
• Stroke mechanisms included cardiogenic embolism, artery-to-artery embolism, cryptogenic embolism, thrombotic MCA (M1) occlusion, thrombotic ICA occlusion, and undetermined causes.
• The lenticulostriate artery group showed higher frequencies of embolism and M1 occlusion, whereas the internal borderzone group had more ICA occlusions.
• Branch atheromatous disease (BAD) is proposed as a cause for 'undetermined' cases, particularly in the lenticulostriate artery territory.

Impact:

• Provides a clearer understanding of the diverse stroke mechanisms contributing to large subcortical infarcts.
• Highlights the distinct etiological profiles of infarcts in different deep cerebral vascular territories.
• Suggests potential etiological roles for branch atheromatous disease in specific LSI subtypes.
• Informs clinical practice regarding the evaluation and management of patients with large subcortical infarcts.