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Updated: Feb 12, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Incidence and Etiology of Microinfarcts in Patients with Ischemic Stroke
Jamary Oliveira-Filho1,2, Hakan Ay1,3, Ashkan Shoamanesh1,4
1Stroke Service, Massachusetts General Hospital, Boston, MA.
Background And Purpose:
Cerebral microinfarcts (CMI) are associated with intracerebral hemorrhage due to small vessel disease (SVD) in studies not including an ischemic etiologic workup. We aimed to determine their incidence and potential causes in a large ischemic stroke (IS) cohort.
Methods:
Consecutive patients with MRI-confirmed IS within 72 hours of onset were enrolled. Subjects had either single high-risk embolic source (cardioembolic or large vessel disease) or no embolic source. CMIs were classified by their relationship to the primary infarct as within or outside the same vascular territory. White matter hyperintensities (WMH) and microbleeds were markers SVD severity. Multivariable regression tested the association between CMIs and potential etiologies.
Results:
We analyzed 946 IS patients, mean age 69 ± 15 years, 46% female. We detected CMI (≤5 mm) on diffusion-weighted imaging in 269 (28%) subjects, 190 (71%) within the vascular territory of the primary infarct. Large-vessel atherosclerosis (P <.001), cardioembolic source (P <.001), higher WMH (P = .032) and lower systolic blood pressure (SBP, P = .024) were independently associated with the presence of CMI. While SBP was associated with CMI in any location (P <.05), WMH was only associated with CMI outside the territory of the primary infarct (P = .033), and large vessel atherosclerosis with CMI within the primary infarct territory (P = .004).
Conclusions:
CMIs occurring within the vascular territory of a larger infarct are more likely embolic, but those occurring outside are probably related to SVD. Our findings suggest a role for SVD in pathogenesis of CMIs and emphasize the importance of etiologic workup to identify alternate etiologies.
Insights
Cerebral microinfarcts (CMI) are common in ischemic stroke patients. While some are embolic, many outside the main stroke area suggest small vessel disease (SVD) as a cause.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- Cerebral microinfarcts (CMI) are linked to intracerebral hemorrhage and small vessel disease (SVD).
- Previous studies often excluded patients undergoing thorough ischemic stroke (IS) etiologic workup.
- The incidence and causes of CMIs in IS cohorts require further investigation.
Purpose of the Study:
- To determine the incidence of CMIs in a large cohort of ischemic stroke patients.
- To investigate the potential causes and associations of CMIs within this cohort.
- To differentiate between embolic and SVD-related CMIs based on their location relative to the primary infarct.
Main Methods:
- Analysis of 946 consecutive patients with MRI-confirmed ischemic stroke within 72 hours of onset.
- Classification of CMIs based on their location relative to the primary infarct (within or outside the same vascular territory).
- Assessment of small vessel disease markers (white matter hyperintensities, microbleeds) and multivariable regression to identify associations.
Main Results:
- Cerebral microinfarcts (CMI) were detected in 28% of ischemic stroke (IS) patients.
- CMI presence was independently associated with large-vessel atherosclerosis, cardioembolic source, higher white matter hyperintensities (WMH), and lower systolic blood pressure (SBP).
- WMH correlated with CMIs outside the primary infarct territory, while large vessel atherosclerosis correlated with CMIs within the territory.
Conclusions:
- CMIs within the primary infarct territory are likely embolic.
- CMIs outside the primary infarct territory suggest a role for small vessel disease (SVD) in their pathogenesis.
- Comprehensive etiologic workup is crucial for identifying the causes of CMIs in ischemic stroke patients.
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