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Published on: July 21, 2013
Cortex-sparing infarctions in patients with occlusion of the middle cerebral artery
Han Jin Cho1, Jae Hoon Yang, Yo Han Jung
1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Background:
In patients with a middle cerebral artery (MCA) occlusion, the involvement of the cortex may be affected by the presence of leptomeningeal anastomoses between the cerebral arteries.
Methods:
The authors enrolled consecutive patients with acute infarctions in the MCA territory and MCA occlusion on angiographic studies. Infarct patterns were classified into three categories based on the extent of cortical surface involvement: total cortex (TC), partial cortex (PC) and no cortex (NC). The authors analysed the infarction patterns by stroke subtype, and investigated factors that resulted in cortex sparing.
Results:
Out of 73 total patients, cortex-sparing infarctions were seen in 53 patients (72.6%, NC in 39 (53.5%) and PC in 14 (19.1%)). The extent of cortical involvement differed according to stroke subtype (p=0.036). TC was more frequent (42.9% vs 22.2%), and PC was less frequent (10.7% vs 27.9%, p=0.037) in cardioembolism than large-artery atherosclerosis. However, the proportion of patients with complete cortical sparing (NC) was similar between cardioembolism and large-artery atherosclerosis (46.4% vs 49.9%). In the upstream of leptomeningeal collateral arteries, the extent of cortical involvement was associated with significant stenosis of the ipsilateral anterior or posterior cerebral artery (p=0.011).
Conclusion:
This study suggests that pre-existing arteriolar connections, which may cover almost entire cortical surfaces of the MCA territory, exist in many patients. The findings also suggest that the extent of cortical involvement is different between stroke subtypes, and is critically affected by the status of upstream collateral arteries.
Insights
Many stroke patients exhibit cortex-sparing middle cerebral artery (MCA) infarctions due to leptomeningeal anastomoses. Stroke subtype and upstream collateral artery status significantly influence cortical involvement extent.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Middle cerebral artery (MCA) occlusions can impact cortical involvement.
- Leptomeningeal anastomoses between cerebral arteries may influence MCA territory infarct patterns.
Purpose of the Study:
- To classify infarct patterns in MCA territory occlusions.
- To analyze infarction patterns by stroke subtype.
- To investigate factors contributing to cortex sparing in MCA occlusions.
Main Methods:
- Consecutive patients with acute MCA territory infarctions and MCA occlusion on angiography were enrolled.
- Infarct patterns were categorized as total cortex (TC), partial cortex (PC), or no cortex (NC).
- Analysis included stroke subtypes and factors influencing cortex sparing.
Main Results:
- Cortex-sparing infarctions (NC or PC) occurred in 72.6% of 73 patients.
- Cortical involvement extent varied by stroke subtype (p=0.036), with cardioembolism showing more TC and less PC than large-artery atherosclerosis.
- Complete cortical sparing (NC) was similar between cardioembolism and large-artery atherosclerosis.
- Upstream leptomeningeal collateral artery status correlated with cortical involvement, particularly with ipsilateral anterior or posterior cerebral artery stenosis (p=0.011).
Conclusions:
- Pre-existing arteriolar connections likely cover extensive MCA territory cortical surfaces in many patients.
- The extent of cortical involvement in MCA occlusions differs by stroke subtype.
- Upstream collateral artery status critically affects cortical involvement in MCA occlusions.
