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Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
Published on: February 17, 2013
Patterns of perfusion-weighted imaging in patients with carotid artery occlusive disease
Claudia J Chaves1, Irina Staroselskaya, Italo Linfante
1Department of Neurology, Lahey Clinic, Burlington, Mass 01805, USA. claudia.j.chaves@lahey.org
Insights
Perfusion-weighted imaging (PWI) identified distinct patterns of brain perfusion related to stroke symptoms in patients with internal carotid artery (ICA) disease. These findings support hypoperfusion as a key factor in carotid artery occlusive disease pathophysiology.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Hemodynamic factors in internal carotid artery (ICA) stenosis or occlusion and their role in stroke pathophysiology are debated.
- Perfusion-weighted imaging (PWI) may offer insights into these hemodynamic changes.
Purpose of the Study:
- To determine if PWI can categorize patients with symptomatic and asymptomatic ICA occlusive disease based on pathophysiological patterns.
- To correlate PWI findings with clinical presentation and degree of ICA stenosis/occlusion.
Main Methods:
- Thirty-eight patients with ICA occlusion or severe stenosis underwent PWI.
- PWI patterns were analyzed in relation to clinical presentation (stroke, transient ischemic attack, asymptomatic) and degree of ICA disease.
Main Results:
- Three PWI patterns emerged: extensive hypoperfusion (25 patients), localized border zone deficits (8 patients), and normal perfusion (5 patients).
- Extensive deficits correlated with acute stroke, while border zone deficits were more common in transient ischemic attacks.
- Asymptomatic patients showed normal perfusion; patterns were independent of occlusion vs. severe stenosis.
Conclusions:
- PWI patterns correlate with clinical presentation in ICA occlusive disease, not the degree of stenosis.
- These findings support the hypothesis that hypoperfusion significantly contributes to the pathophysiology of carotid artery occlusive disease.
Background:
The importance of hemodynamic factors in the pathophysiology of stroke and transient ischemic attacks in patients with internal carotid artery (ICA) stenosis or occlusion remains controversial.
Objective:
To investigate whether perfusion-weighted imaging (PWI) could identify pathophysiologically meaningful categories in patients with symptomatic and asymptomatic ICA occlusive disease.
Methods:
Thirty-eight consecutive patients with occlusion (22 patients) or severe stenosis (16 patients) of the ICA, determined by ultrasonography or magnetic resonance angiography, were identified from the Beth Israel Deaconess Medical Center Stroke Database, Boston, Mass. Thirty-five patients were symptomatic (29 who had strokes and 6 who had transient ischemic attacks) and 3 were asymptomatic. All symptomatic patients underwent PWI within the first 24 hours after symptom onset. The patterns of PWI were analyzed according to the degree of ICA stenosis and the clinical presentation.
Results:
Three patterns of perfusion abnormalities were identified: extensive hypoperfusion involving the middle cerebral arterial and/or anterior cerebral arterial territories (25 patients), localized perfusion deficits involving predominantly the ipsilateral border zone areas (8 patients), and normal perfusion (5 patients). All 3 patterns were found whether or not the ICA was occluded. Patients who had acute stroke most frequently had extensive perfusion deficits involving 1 or 2 territories while patients who had transient ischemic attacks often had hypoperfusion affecting the border zone regions. All asymptomatic patients had normal perfusion.
Conclusions:
In our sample the pattern of PWI related to the clinical presentation but not to the degree of ICA disease (occlusive vs severe stenosis). Our study findings add further support to the hypothesis that hypoperfusion is a major contributing factor in the pathophysiology of carotid artery occlusive disease.
