Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases
ABSTRACT The mechanism of ischemic stroke in intracranial branch atheromatous disease (BAD) is different from large artery atherothrombotic disease (LAD) or lacunar infarction (LACI). The concept of BAD is underused in clinical practice and research.
Patients admitted over 24-months with ischemic stroke caused by atherosclerotic disease were reviewed retrospectively and classified according to radiological±clinical criteria into LAD, BAD and LACI. The BAD cases were further divided into 5 BAD syndromes. Clinical characteristics, vascular risk factors, results of vascular workup and outcome among these subgroups were compared.
123 cases of LAD (17% of all stroke patients or 33% of all studied patients), 147 BAD (20% or 40%) and 102 LACI (14% or 27%) presented during the study period. Compared to LAD, BAD patients had milder neurological deficits, were less often diabetic and carotid stenosis was less common, while stenosis of the intracranial arteries was more frequent in BAD as compared with LACI patients. Outcome in BAD patients was intermediate between LAD and LACI. Comparisons among the BAD syndromes indicated they were homogenous conditions.
BAD is the most prevalent ischemic stroke subtype in our cohort. The homogeneity among the BAD syndromes suggests they might represent a distinctive stroke entity.
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ABSTRACT: High-resolution magnetic resonance imaging (HRMRI) has a unique ability to provide an evaluation of the intracranial artery wall. This study aimed to investigate the possible mechanisms of ischemic stroke in patients with intracranial atherosclerosis using HRMRI. HRMRI was performed on 55 patients (38 male and 17 female) with acute cerebral infarction to investigate the lumen-intruding plaque at the stenotic portion of the middle cerebral artery (MCA) and basilar artery (BA) and to attempt to identify the mechanisms of stroke. Penetrating artery disease (PAD) was diagnosed in 20 patients (36%) and large-artery atherosclerosis (LAA) was diagnosed in 35 patients, including 19 with parent artery plaques occluding a penetrating artery (POPA; 35%) and 16 with artery-to-artery embolisms (29%). Patients with PAD had a higher frequency of hypertension compared with that of the patients with LAA (80 versus 29%; P<0.001), and patients with LAA had a higher frequency of diabetes compared with that of the patients with PAD (40% versus 15%; P=0.054). Magnetic resonance angiography revealed mild to moderate stenosis in the patients with POPA, while border zone infarction and artery-to-artery embolism occurred in the majority of the patients with severe stenosis or occlusion of the MCA and BA. HRMRI has the ability to identify the mechanisms of intracranial atherosclerotic ischemic stroke through the detection of luminal plaques.Experimental and therapeutic medicine 05/2014; 7(5):1415-1419. DOI:10.3892/etm.2014.1600 · 0.94 Impact Factor
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ABSTRACT: We aimed to explore the association between abnormal glucose metabolism such as diabetes, prediabetes, and short-term prognosis in patients with acute ischemic stroke. Of 242 consecutive acute ischemic stroke patients, a 75-g oral glucose tolerance test was administered to 116 patients without previously diagnosed diabetes. One hundred forty patients were classified into diabetes, 52 patients were prediabetes (impaired glucose tolerance or impaired fasting glucose or both), and 50 patients were normal glucose tolerance (NGT). The association between each glycemic status and early neurological deterioration (END; increase in the NIH Stroke Scale (NIHSS) of ≥2 points during the first 14days after admission) or poor short-term outcome (30-day modified Ranking Scale [mRS] score 2-6) was evaluated. In multivariable analysis, the risk of END was significantly higher in the diabetes group than in the NGT group (ORs=11.354; 95% CI, 1.492-86.415; p=0.019), even after adjustment for possible confounding factors (ORs=12.769; 95% CI, 1.361-119.763; p=0.026). Similar but insignificant associations were observed between prediabetes and NGT groups (ORs=6.369; 95% CI, 0.735-55.177; p=0.093). The risk of poor outcome (30-day mRS 2-6) was significantly higher in the diabetes group (ORs=3.667; 95% CI, 1.834-7.334; p<0.001) than in the NGT group, even after adjusting for confounding factors (ORs=3.340; 95% CI, 1.361-8.195; p=0.008). Similar but insignificant associations were observed between prediabetes and NGT groups (ORs=2.058; 95% CI, 0.916-4.623; p=0.08). In our patient population, both diabetes and prediabetes were associated with a poor early prognosis after acute ischemic stroke.Journal of the neurological sciences 06/2013; 332(1-2). DOI:10.1016/j.jns.2013.06.010 · 2.26 Impact Factor
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ABSTRACT: BACKGROUND: The objective of this study was to evaluate treatment outcomes of tissue plasminogen activator (t-PA) infusion for hyperacute branch atheromatous disease (BAD) within 3 hours after onset. METHODS: A total of 152 BAD patients with lenticulostriate artery (LSA) or paramedian pontine artery (PPA) territory infarcts (LSA 114; PPA 38) were hospitalized between April 2007 and June 2012. Of these, 21 BAD patients (LSA 19; PPA 2) arrived at the hospital within 3 hours after onset, and, among these, 8 patients who received t-PA infusion (.6 mg/kg) were included in this study. All BAD patients who received t-PA infusion had LSA territory infarcts. RESULTS: Six of 8 patients (75%) had improvement of neurologic findings within 60 minutes after t-PA infusion, but neurologic findings deteriorated within 24 hours in 4 of these patients (67%). In all patients with deterioration, diffusion-weighted imaging after 24 hours revealed infarct expansion. One patient (13%) had symptomatic intracranial hemorrhage. After 3 months, the modified Rankin Scale (mRS) score was 0 to 2 in 6 patients (75%) and 3 to 6 in 2 patients (25%). CONCLUSIONS: With t-PA infusion for BAD, symptoms transiently improved, but the rate of symptom deterioration was high. The outcome after 3 months was relatively good.Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 12/2012; 22(7). DOI:10.1016/j.jstrokecerebrovasdis.2012.10.012 · 1.99 Impact Factor