Acute cerebral infarcts in multiple arterial territories associated with cardioembolism
V Novotny1,2, L Thomassen1,2, U Waje-Andreassen1
1Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Objectives:
It is generally believed that cardioembolism is the main cause of multiple acute cerebral infarcts (MACI). However, there are surprisingly few DWI studies and results are conflicting. Based on a large prospective study we hypothesized that MACI are associated with cardioembolism.
Materials And Methods:
We studied 2697 patients with acute cerebral infarcts between February 2006 and October 2013 who were prospectively registered in The Bergen NORSTROKE Registry. Among them, 2220 (82.3%) patients underwent magnetic resonance imaging (MRI) and 2125 (96%) of these 2220 patients had DWI lesions. Only patients with DWI lesions were included. MACI were defined as at least two DWI lesions in at least two different arterial territories.
Results:
MACI were detected in 187/2125 (8.8%) patients with DWI lesions. MACI patients were older and more often females. MACI were associated with cardioembolism (P = 0.042), especially atrial fibrillation (P = 0.002). Other associations were symptomatic internal carotid artery (ICA) stenosis (P = 0.014), asymptomatic ICA stenosis (P = 0.036), and higher NIHSS score on admission (P < 0.001). Among patients with no cardioembolism, 34 (35%) with MACI had symptomatic ICA stenosis versus 268 (25.0%) with non-MACI (P = 0.037); 20 (20%) with MACI had asymptomatic ICA stenosis versus 134 (13%) with non-MACI (P = 0.031). In the logistic regression analysis, cardiac embolism and symptomatic ICA stenosis were independently associated with MACI.
Conclusions:
Acute cerebral infarcts in more than one arterial territory occur among almost 10% of the patients and are associated with cardioembolism.
Insights
Multiple acute cerebral infarcts (MACI) occur in nearly 10% of stroke patients and are linked to cardioembolism, particularly atrial fibrillation. This study confirms cardioembolism as a significant cause of multiple brain infarcts.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Multiple acute cerebral infarcts (MACI) are often attributed to cardioembolism, but supporting DWI (diffusion-weighted imaging) evidence is limited and conflicting.
- This study investigates the association between MACI and cardioembolic sources using a large prospective cohort.
Purpose of the Study:
- To test the hypothesis that MACI are associated with cardioembolism.
- To identify etiological factors contributing to MACI.
Main Methods:
- Prospective registration of 2697 acute cerebral infarct patients in The Bergen NORSTROKE Registry (2006-2013).
- Inclusion of 2125 patients with DWI lesions confirmed by MRI.
- Definition of MACI as ≥2 DWI lesions in ≥2 arterial territories.
Main Results:
- MACI were identified in 8.8% of patients with DWI lesions.
- MACI were significantly associated with cardioembolism (P=0.042), especially atrial fibrillation (P=0.002).
- Independent associations with MACI included symptomatic internal carotid artery (ICA) stenosis and higher NIHSS scores.
Conclusions:
- Nearly 10% of acute cerebral infarct patients present with multiple infarcts across different arterial territories.
- Cardioembolism is a significant etiological factor for MACI, underscoring the importance of cardiac evaluation in stroke patients.
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