Abstract
BackgroundIt is usually difficult to identify stroke pathogenesis for single lenticulostriate infarction with nonstenotic middle cerebral artery (MCA). Our aim is to differentiate the two pathogeneses, non-branch atheromatous small vessel disease and branch atheromatous disease (BAD) by high-resolution magnetic resonance imaging (HR-MRI).MethodsThirty-two single lenticulostriate infarction patients with nonstenotic MCA admitted to the China-Japan Friendship Hospital from December 2014 to August 2017 were enrolled for retrospective analysis. National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), atherosclerotic risk factors, imaging features, and the characteristic of MCA vessel wall in HR-MRI were evaluated.ResultsMCA plaques were detected in 15(46.9%) patients which implied BAD and 8 of 15 (53.3%) patients had plaques location in upper dorsal side of the vessel wall. Patients with HR-MRI identified plaques had a significantly larger infarction lesion length (1.95 ± 0.86 cm versus 1.38 ± 0.55 cm; P = 0.031) and larger lesion volume (2.95 ± 3.94 cm3 versus 0.90 ± 0.94 cm3; P = 0.027) than patients without plaques. Patients with HR-MRI identified plaques had a significant higher percentage of proximal lesions than patients without plaques (P = 0.055). However, according to the location of MCA plaques, there were no significant differences in terms of imaging features, NIHSS and mRS.ConclusionWe demonstrated high frequency of MCA atheromatous plaques visualized in single lenticulostriate infarction patients with nonstenotic MCA by using HR-MRI. Patients with HR-MRI identified plaque presented larger infarction lesions and more proximal lesions than patients without plaque, which were consistent with imaging features of BAD. HR-MRI is an important and effective tool for identifying stroke etiology in patients with nonstenotic MCA.
Highlights
It is usually difficult to identify stroke pathogenesis for single lenticulostriate infarction with nonstenotic middle cerebral artery (MCA)
Pathogenesis diagnosis of ischemic stroke is important for patient management
It is usually difficult to distinguish branch atheromatous disease (BAD) from non-branch atheromatous small vessel disease for lenticulostriate infarction patients with nonstenotic MCA by using traditional imaging examinations
Summary
It is usually difficult to identify stroke pathogenesis for single lenticulostriate infarction with nonstenotic middle cerebral artery (MCA). Our aim is to differentiate the two pathogeneses, non-branch atheromatous small vessel disease and branch atheromatous disease (BAD) by high-resolution magnetic resonance imaging (HR-MRI). Lenticulostriate infarction is ischemia in the territory supplied by the deep perforating branches of the middle cerebral artery (MCA). There are two different vascular pathogenesis in single lenticulostriate infarction with nonstenotic MCA: 1) branch atheromatous disease (BAD), atheromatous plaque of MCA at the orifice of lenticulostriate arteries and 2) non-branch atheromatous small vessel disease, histologically characterized by lipohyalinotic degeneration of lenticulostriate arteries themselves [3]. BAD was proposed by Caplan in 1989 [4] It was identified as a new pathogenesis caused by an occlusion or stenosis at the origin of a deep penetrating artery of the brain. Nonbranch atheromatous small vessel disease is different from BAD showed lower mortality and higher risk of death when with anticoagulant therapy [1]
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