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Differential pathophysiological mechanisms of stroke evolution between new lesions and lesion growth:

Oh Young Bang1, Gyeong Moon Kim, Chin Sang Chung

  • 1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. nmboy @ unitel.co.kr

Cerebrovascular Diseases (Basel, Switzerland)
|February 5, 2010
PubMed
Abstract

Insights

Stroke evolution types vary based on initial perfusion severity. New lesions occurred in mild hypoperfusion, while infarct growth happened in severe areas, influencing treatment outcomes.

Area of Science:

  • Neuroscience
  • Radiology
  • Cerebrovascular Diseases

Background:

  • Stroke evolution is common in the first week post-stroke.
  • The relationship between stroke evolution patterns and baseline perfusion severity remains under-investigated.

Purpose of the Study:

  • To investigate the association between stroke evolution types (new lesions vs. infarct growth) and baseline perfusion severity in acute middle cerebral artery infarcts.
  • To explore the influence of recanalization therapy on stroke evolution patterns.

Main Methods:

  • Analysis of clinical and serial MRI data from 74 patients with acute middle cerebral artery infarcts.
  • Multimodal MRI acquisition before treatment and on day 7.
  • Generation of Time to Peak (Tmax) perfusion lesion maps and classification of diffusion-weighted imaging (DWI) changes (new lesions or infarct growth).

Main Results:

  • New lesions were observed in 52.7% of patients, while infarct growth occurred in 52 patients; no significant correlation was found between new lesions and infarct growth.
  • New lesions were typically small, cortical, and associated with mild perfusion delay (2 ≤ Tmax < 4s), whereas infarct growth occurred in regions with severe perfusion delay (Tmax ≥ 4s).
  • Large mild perfusion delay independently predicted new lesions; large initial DWI lesions and severe perfusion delay predicted infarct growth. Endovascular therapy correlated with new lesions, while recanalization degree inversely correlated with infarct growth.

Conclusions:

  • Stroke evolution patterns differ based on baseline hypoperfusion severity and recanalization therapy.
  • New lesions and infarct growth represent distinct evolution pathways with different radiological and clinical implications.
  • Baseline perfusion severity and treatment modality are key determinants of stroke evolution post-middle cerebral artery infarct.

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