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Updated: Jul 2, 2026
Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
Published on: February 17, 2013
Differential patterns of evolution in acute middle cerebral artery infarction with perfusion-diffusion mismatch:
Hye-Jin Kim1, Sung-Cheol Yun, Kyung-Hee Cho
1Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
Background:
An acute perfusion-diffusion mismatch is known to be the strongest predictor of infarct growth. However, the differential patterns of clinical and radiological evolution according to stroke mechanism are unknown.
Methods:
The study retrospectively reviewed consecutive patients who had 1) acute middle cerebral artery (MCA) territory infarction, 2) diffusion- and perfusion-weighted imaging (DWI and PWI) and MR angiography within 24 h of onset, and follow-up DWI 5 days later, 3) stenosis (> or =50%) or occlusion of MCA on baseline imaging, 4) a baseline PWI-DWI mismatch >20%, and 5) either atherosclerotic MCA disease (MCAD) or cardioembolism (CE). National Institutes of Health Stroke Scale (NIHSS) scores and infarct volume at baseline and 5 days were obtained.
Results:
Of 90 patients, 52 had MCAD and 38 had CE. At baseline, CE group had more severe stroke (median NIHSS, 9 vs. 5; p=0.001) and larger infarct volume (median 8.32 cc vs. 3.0 cc; p=0.034) than MCAD group. During the 1-week period, CE group had larger infarct volume growth (median 12.85 cc vs. 3.02 cc; p=0.004) than MCAD group, although clinical improvement based on NIHSS (baseline minus 5-day) tended to be higher for CE than MCAD group (median 3 vs. 1; p=0.08). The correlation between infarct volume and NIHSS score was stronger in CE (r=0.841) compared to MCAD (r=0.582) group at 5-day.
Conclusions:
Substantial differences in the clinico-radiological evolution of acute ischemic stroke exist according to stroke mechanism. These data emphasize the importance of the stroke mechanism in the design of MRI-based acute stroke trials.
Insights
Stroke mechanism significantly impacts acute ischemic stroke evolution. Cardioembolism (CE) patients showed greater infarct growth and stronger NIHSS correlation than atherosclerotic MCA disease (MCAD), highlighting mechanism importance in trials.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Acute perfusion-diffusion mismatch predicts infarct growth.
- Differential clinical and radiological evolution based on stroke mechanism is not well understood.
Purpose of the Study:
- To investigate the differences in clinical and radiological outcomes of acute ischemic stroke between atherosclerotic middle cerebral artery disease (MCAD) and cardioembolism (CE) stroke mechanisms.
Main Methods:
- Retrospective review of 90 patients with acute MCA infarction within 24 hours of onset.
- Inclusion criteria: DWI/PWI mismatch >20%, MCA stenosis/occlusion, and follow-up DWI at 5 days.
- Comparison of NIHSS scores and infarct volumes between MCAD and CE groups.
Main Results:
- CE patients presented with more severe strokes (NIHSS 9 vs. 5) and larger baseline infarct volumes (8.32 cc vs. 3.0 cc) compared to MCAD.
- CE group exhibited significantly greater infarct volume growth (12.85 cc vs. 3.02 cc) over one week.
- A stronger correlation between infarct volume and NIHSS score was observed in the CE group at 5-day follow-up (r=0.841 vs. r=0.582).
Conclusions:
- Significant variations in clinico-radiological evolution exist between MCAD and CE stroke mechanisms.
- Stroke mechanism is a critical factor to consider in the design of MRI-based acute stroke clinical trials.
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