Branching patterns determine the size of single subcortical infarctions

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Single subcortical infarcts (SSIs) exhibit size variations potentially due to differing stroke mechanisms or perforator artery branching.
• High-resolution magnetic resonance imaging (MRI) allows detailed investigation of these factors.

Purpose of the Study:

• To investigate the association between SSI size and the branching patterns of perforator arteries using high-resolution MRI.
• To explore whether stroke mechanisms or vascular anatomy better explains SSI size variation.

Main Methods:

• Patients with high-resolution MRI-identified SSIs and no significant middle cerebral artery stenosis were analyzed.
• Perforator stems and branches were quantified, and a branching index was calculated.
• Clinical and imaging data were compared between large (≥20 mm) and small SSI groups.

Main Results:

• Larger SSIs were associated with diabetes mellitus and severe neurological deficits.
• The number of perforator branches and the branching index were significantly higher in the large SSI group compared to the small SSI group.
• SSI diameter strongly correlated with both the number of perforator branches and the branching index.

Conclusions:

• SSI size appears predominantly influenced by the anatomical variation in perforator artery branching.
• Current diagnostic criteria for small vessel disease based solely on lesion diameter may be insufficient.