Correlation between the watershed infarction types and cerebrovascular stenosis

Abstract

Objective To investigate the correlation between the cerebral watershed infarction (WSI) types and cerebrovascular stenosis. Methods Patients with WSI diagnosed by MRI and diffusion-weighted imaging were enrolled. Color Doppler ultrasound was used to conduct extracranial internal carotid artery (ICA) examination. Magnetic resonance angiography was used to conduct intracranial vascular examination. The patients with WSI were divided into cortical watershed infarction (CWSI), internal watershed infarction (IWSI), and mixed-type watershed infarction (MWSI). The correlation between the different types of WSI and cerebral vascular stenosis were analyzed. Results A total of 120 patients with WSI were enrolled, including 18 with CWSI, 48 with IWSI, and 54 with MWSI. Ipsilateral vascular stenosis: 48 patients were in ICA (40.0%, 22 of them in the extracranial segment, 39 in the intracranial segment), 24 (20.0%) were in the anterior cerebral artery, 86 (71.7%) were in the middle cerebral artery, 40 (33.3%) were in the posterior cerebral artery, 35 (29.2%) were in the vertebral basilar artery, and 36 (30.0%) were in ICA+ MCA. There were significant differences in the detection rates of ipsilateral ICA, MCA and ICA+ MCA stenosis among different types of WSI. Multivariate logistic regression analysis showed that CWSI often accompanied by the ipsilateral ICA stenosis (odds ratio [OR] 0.022; 95% confidence interval [CI] 0.002-0.230; P=0.001); IWSI often accompanied by the MCA stenosis (OR 40.164; 95% CI 3.861-417.810; P=0.002), while MWSI often accompanied by the ipsilateral MCA stenosis (OR 9.586; 95% CI 2.776-33.126; P<0.001) and ipsilateral ICA+ MCA stenoses (OR 7.481; 95% CI 2.541-22.022; P<0.001). Conclusion There were significant differences in the incidence of the ipsilateral ICA, MCA, and ICA+ MCA stenosis among the different types of WSI. CWSI often accompanied by the ipsilateral ICA stenosis, IWSI often accompanied by the ipsilateral MCA stenosis, and MWSI often accompanied by the ipsilateral ICA+ MCA stenosis. Key words: Cerebral Infarction; Carotid Artery Diseases; Intracranial Arterial Diseases; Diffusion Magnetic Resonance Imaging; Magnetic Resonance Angiography; Ultrasonography, Doppler, Duplex