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Factors associated with the laterality of Cardio-Embolic stroke

Ramy Abdelnaby1, Demetris Charalambous1, Khaled A Mohamed2

  • 1Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|November 4, 2023
PubMed

Insights

Left-sided cardio-embolic stroke is predicted by a larger left internal carotid artery angle, bovine aortic arch anatomy, and slower right middle cerebral artery peak systolic velocity. These factors aid in diagnosing stroke laterality.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Imaging

Background:

  • Diagnosing cardio-embolic stroke requires understanding lateralization factors.
  • Anatomic and hemodynamic mechanisms influencing stroke laterality are crucial.
  • Previous studies have not comprehensively investigated combined lateralization predictors.

Purpose of the Study:

  • To investigate combined anatomic and hemodynamic factors affecting stroke laterality.
  • To identify predictors for left-sided cardio-embolic stroke.
  • To enhance the diagnostic approach for stroke laterality.

Main Methods:

  • A monocentric retrospective case-control study of 222 acute ischemic stroke patients.
  • Inclusion criteria: cardio-embolic stroke, unilateral large vessel occlusion, anterior circulation.
  • Assessment of internal carotid artery (ICA) angle, aortic arch (AA) branching, and middle cerebral artery (MCA) peak systolic velocity (PSV) asymmetry using CT-Angiography and Doppler.

Main Results:

  • Increased left ICA angle, bovine type AA anatomy, and slower right MCA PSV (>15% difference) predicted left stroke.
  • Slower right MCA PSV was an independent predictor for left stroke (OR=3.341).
  • Inter-rater reliability for assessments ranged from moderate to perfect.

Conclusions:

  • Left stroke lateralization is associated with specific anatomic and hemodynamic factors.
  • Higher left ICA angle, bovine AA anatomy, and slower right MCA PSV are key predictors.
  • Findings contribute to understanding and diagnosing stroke laterality in cardio-embolic events.
Abstract

Keywords:
EmbolicLateralityRisk factorsStroke

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