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Published on: January 23, 2019
Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted
Dae K Lee1, Jong S Kim, Sun U Kwon
1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Background And Purpose:
Patterns and mechanisms of stroke in patients with atherosclerotic middle cerebral artery (MCA) disease remain unclear. We sought to identify lesion patterns and stroke mechanisms associated with MCA disease using early diffusion-weighted imaging (DWI).
Methods:
We reviewed 185 acute ischemic stroke patients who had (1) symptomatic lesions located in the unilateral MCA territory on DWI performed within 48 hours of symptom onset, and (2) either corresponding MCA disease, internal carotid artery disease, or cardioembolism. Acute DWI lesion patterns were classified as (1) single (small perforator <2 cm; large perforator > or =2 cm; pial; large territorial; border-zone) and (2) multiple.
Results:
MCA disease was diagnosed in 63 patients, 32 (50.8%) of whom showed multiple lesions. Concomitant perforator and pial infarcts (14/63, P<0.001), concomitant perforator, pial, and border-zone infarcts (9/63, P<0.001), and single small perforator infarcts (12/63, P=0.001) were identified more often in patients with MCA disease than in those with cardioembolism or internal carotid artery disease. Small perforator infarcts were more common in patients with milder stenosis than with severe stenosis or occlusion of MCA (P<0.001). Whether they occurred singly or in addition to other lesions, pial infarcts were identified more often in patients with severe stenosis or occlusion of MCA (P=0.001).
Conclusions:
Perforating artery infarcts, whether single or occurring in addition to pial or border-zone infarcts, are lesion patterns specific for MCA disease. This suggests that local branch occlusion and coexisting distal embolization may be a common stroke mechanism in patients with MCA disease.
Insights
Middle cerebral artery (MCA) disease is linked to specific stroke patterns, including perforating artery and pial infarcts. These findings suggest local branch occlusion and embolization are key stroke mechanisms in MCA disease.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Atherosclerotic middle cerebral artery (MCA) disease is a significant cause of ischemic stroke.
- The precise lesion patterns and stroke mechanisms associated with MCA disease require further elucidation.
Purpose of the Study:
- To identify specific lesion patterns and stroke mechanisms in patients with atherosclerotic MCA disease.
- To utilize early diffusion-weighted imaging (DWI) for stroke pattern analysis.
Main Methods:
- Retrospective review of 185 acute ischemic stroke patients with MCA territory lesions on DWI within 48 hours of onset.
- Inclusion criteria: symptomatic MCA disease, internal carotid artery disease, or cardioembolism.
- Classification of DWI lesion patterns into single (perforator, pial, territorial, border-zone) and multiple infarcts.
Main Results:
- Middle cerebral artery (MCA) disease was present in 63 patients, with 50.8% exhibiting multiple infarcts.
- Concomitant perforator and pial infarcts, or perforator, pial, and border-zone infarcts, were more frequent in MCA disease patients.
- Small perforator infarcts correlated with milder MCA stenosis, while pial infarcts were associated with severe stenosis or occlusion.
Conclusions:
- Perforating artery infarcts, alone or with pial/border-zone infarcts, are characteristic lesion patterns of MCA disease.
- Local branch occlusion and distal embolization are suggested as common stroke mechanisms in MCA disease.
- Early DWI is valuable for differentiating stroke mechanisms in MCA disease.
