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Redefining Infarction Size for Small-Vessel Occlusion in Acute Ischemic Stroke: A Retrospective Case-Control Study
Yen-Chu Huang1,2, Hsu-Huei Weng3, Leng-Chieh Lin4
1Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, Taiwan.
Neurology International
|October 25, 2024
Summary
A proposed 15 mm threshold for small subcortical infarctions (SSIs) may better differentiate small-vessel occlusion from branch atheromatous disease (BAD). Larger infarct sizes and specific clinical factors are associated with early neurological deterioration (END).
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Small-vessel occlusion, a common cause of ischemic stroke, is often defined by infarcts <20 mm.
- Current definitions may not reliably distinguish small-vessel occlusion from branch atheromatous disease (BAD) or embolism.
- Acute small subcortical infarctions (SSIs) require precise diameter-based assessment for accurate diagnosis.
Purpose of the Study:
- To evaluate the clinical significance of acute SSIs based on infarct diameter.
- To determine optimal thresholds for differentiating small-vessel occlusion from BAD.
- To identify predictors of early neurological deterioration (END) in patients with SSIs.
Main Methods:
- Retrospective case-control study of 855 stroke patients (2016-2021).
- Inclusion of patients with acute SSIs in penetrating artery territories.
- Analysis of infarct size, demographics, stroke severity (NIHSS), END, and functional outcomes.
Main Results:
- END occurred in 11.3% of patients, associated with poorer functional outcomes.
- Optimal thresholds identified: 15.5 mm for predicting END and 12.1 mm for BAD.
- Predictors of END included motor tract involvement, heart rate >90 bpm, and larger infarct size (15-20 mm).
Conclusions:
- An upper limit of 15 mm for SSIs may improve differentiation from BAD.
- Findings highlight the prognostic value of infarct size and clinical factors for END.
- Further multi-center studies with advanced imaging are needed to refine diagnostic thresholds.
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