Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases

Department of Medicine, Queen Mary Hospital, University of Hong Kong, China.
Journal of the neurological sciences (Impact Factor: 2.47). 04/2011; 303(1-2):80-4. DOI: 10.1016/j.jns.2011.01.008
Source: PubMed


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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    • "Consequently, among the traditional vascular risk factors, diabetes appears to play a preeminent role in intracranial macroangiopathy in the Chinese population (24). Additionally, the presence of intracranial LAA disease contributes to a poorer outcome for patients with LAA disease, which may be stratified as very high risk in secondary prevention (25). "
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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.
    Full-text · Article · May 2014 · Experimental and therapeutic medicine
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    ABSTRACT: Objective: To investigate progressive cerebral infarction and acute phase outcomes of arterial branch atheromatous disease (BAD) in the territories of the lenticulostriate arteries (LSA) and pontine paramedian arteries (PPA). Methods: A total of 62 consecutive patients with acute cerebral infarction in the territories of LSA and PPA were recruited with a method of prospective study. They were divided into either a BAD group (n = 29) or a non-BAD group (n = 33). The modified Rankin scale (mRS) was used to evaluate the patients in both groups at discharge. The incidences of BAD and progressive cerebral infarction and the acute phase outcomes in the two blood supply territories in patients with cerebral infarction were analyzed. Results: There were no significant differences in the risk factors for cerebrovascular disease between the BAD group and non-BAD group. Circled digit oneThere were 43 patients (69.4%) with LSA cerebral infarction, accounting for 69.4%; there were 19 patients (30.6%) with PPA cerebral infarction, accounting for 30.6%. The incidence of BAD was 46.8% (29/62) in the whole group, and the incidences of BAD in patients with LSA and PPA cerebral infarction were 46.5% and 47.4% respectively. The incidence of progressive stroke in the BAD group was 51.7% (15/29); while it was 18.2% (6/33) in the non-BAD group. There was significant difference (P < 0.01). Circled digit twoThe patients with good clinical outcome at discharge (mRS ≤2) was 51.7% (15/29) in the BAD group, and it was 93.9% (31/33) in the non-BAD group. There was significant difference (P < 0. 01). Conclusion: The incidence of arterial branch atheromatous disease is high in patients with lenticulostriate arteries and pontine paramedian arteries cerebral infarction, the patients with acute phase arterial branch atheromatous disease are easy to progress and their clinical outcomes are poor.
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    ABSTRACT: Single small subcortical infarction (SSSI), also called lacunar infarction, has been regarded as a different entity with distinct pathogenesis, either lipohyalinosis and fibrinoid degeneration or atherosclerosis. The aim of our study is to identify the heterogeneity of SSSI by comparing the characteristics and imaging features according to lesion location. We retrospectively studied 203 patients with acute SSSIs (diameter ≤20 mm) demonstrated by diffusion-weighted imaging in the perforator territory of the middle cerebral artery, basilar artery, or vertebral artery. We divided the 203 patients according to the lesion location in relation to the parent artery into a distal infarction (dSSSI) group and a proximal infarction (pSSSI) group. We evaluated and compared the imaging features and clinical characteristics between the groups. The evaluated characteristics included indicators of lipohyalinosis [leukoaraiosis and silent brain infarction (SBI)], indicators of atherosclerosis [parent artery disease (PAD) and atherosclerosis of other cerebral arteries (AOCA)], lesion size, and some vascular risk factors. Between the two groups, the pSSSI group had larger lesion size, higher prevalence of PAD and AOCA, and greater frequency of diabetes mellitus, while the dSSSI group had smaller lesion size, higher prevalence of leukoaraiosis and SBI, and lower serum folic acid. Diversity of the SSSIs in imaging features and clinical characteristics according to lesion location suggests the heterogeneity of SSSIs; distal infarction is closely associated with lipohyalinosis, while proximal infarction seems to be related with atherosclerosis.
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