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Patterns of infarction in hemodynamic failure

Colin P Derdeyn1, David A Carpenter, Tom O Videen

  • 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. derdeync@wustl.edu

Cerebrovascular Diseases (Basel, Switzerland)
|May 24, 2007
PubMed

Insights

Stroke in patients with carotid occlusion and hemodynamic failure is often thromboembolic, involving both plaque and blood flow issues. This suggests a combined mechanism contributes to large artery thromboembolic stroke.

Area of Science:

  • Neurology
  • Cerebrovascular Disease
  • Medical Imaging

Background:

  • Atherosclerotic occlusive disease and hemodynamic failure can lead to stroke through hemodynamic or embolic mechanisms.
  • Understanding stroke mechanisms in these patients is crucial for risk stratification and management.

Purpose of the Study:

  • To investigate the clinical and imaging features of ischemic stroke in patients with atherosclerotic carotid artery occlusion and hemodynamic compromise.
  • To differentiate between hemodynamic and embolic factors contributing to stroke in this population.

Main Methods:

  • Prospective study of 11 patients with complete atherosclerotic carotid artery occlusion and elevated hemisphere oxygen extraction fraction.
  • Review of medical records and imaging to characterize stroke type, location (MCA core, cortical border zone, internal border zone), and associated clinical features like hypotension.
  • Assessment of neurological deficits and infarct patterns.

Main Results:

  • Ten of eleven patients experienced middle cerebral artery (MCA) territory strokes; one had a retinal infarction.
  • Six MCA strokes occurred in the MCA core territory, with two resulting in fatal hemispheric events.
  • Infarcts were also observed in cortical and internal border zones, indicating diverse stroke patterns.

Conclusions:

  • Clinical and radiological findings suggest large artery thromboembolic stroke is common in patients with carotid occlusion and hemodynamic impairment.
  • A synergistic interaction between embolic and hemodynamic factors likely contributes to the pathogenesis of large artery thromboembolic stroke.
Abstract

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