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Intracranial atherosclerotic disease mechanistic subtypes drive hypoperfusion patterns

Song J Kim1, Jose M Morales1, Shadi Yaghi2

  • 1Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
|April 30, 2021
PubMed

Insights

Symptomatic intracranial atherosclerosis (ICAS) stroke patterns correlate with distinct hypoperfusion volumes. Internal borderzone (IBZ) and thromboembolic (TE) patterns show greater perfusion delays than branch occlusive disease (BOD).

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Symptomatic intracranial atherosclerotic stenosis (ICAS) is linked to recurrent stroke risk.
  • Borderzone infarcts and perfusion mismatch in ICAS suggest hypoperfusion as a key mechanism.
  • Understanding ICAS mechanistic subtypes is crucial for predicting stroke recurrence.

Purpose of the Study:

  • To investigate the correlation between hypoperfusion volumes and specific infarct patterns in symptomatic ICAS.
  • To differentiate perfusion characteristics across mechanistic subtypes of ICAS: branch occlusive disease (BOD), internal borderzone (IBZ), and thromboembolic (TE).

Main Methods:

  • Retrospective analysis of 42 consecutive symptomatic ICAS patients with acute strokes.
  • Classification of ICAS mechanistic subtypes based on diffusion-weighted imaging infarct patterns: BOD, IBZ, and TE.
  • Assessment of perfusion parameters (Tmax > 4s, Tmax > 6s) and mismatch volumes using MRI.

Main Results:

  • The IBZ pattern showed significantly higher Tmax > 4s and Tmax > 6s perfusion delay volumes and mismatch volumes compared to BOD.
  • TE patterns exhibited greater median Tmax > 6s hypoperfusion delay volumes than BOD.
  • A substantial difference in Δ Tmax > 4s - Tmax > 6s was observed between IBZ and TE patterns.

Conclusions:

  • Intracranial atherosclerotic stenosis (ICAS) infarct patterns correlate with distinct perfusion profiles.
  • These findings support the hypothesis that different ICAS mechanistic subtypes have unique underlying hypoperfusion characteristics.
  • Perfusion imaging may aid in differentiating ICAS subtypes and assessing stroke risk.
Abstract

Keywords:
MRI DWIintracranial atherosclerosisperfusion

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