Abstract
The hemodynamic changes of acute small subcortical infarction (SSI) are not well understood. We evaluate the hemodynamic changes and collaterals in acute SSI using perfusion magnetic resonance imaging (MRI). A total of 103 patients with acute SSI in penetrating artery territories were recruited and underwent MRI within 24 h of stroke onset. Using 4D dynamic perfusion MRI, they were divided into three patterns: 25 (24%) with normal perfusion, 31 (30%) with compensated perfusion, and 47 (46%) with hypoperfusion. The development of anterograde or retrograde collaterals was also evaluated. Patients with hypoperfusion pattern had the highest rate of early neurological deterioration (32%, p = 0.007), the largest initial and final infarction volumes (p < 0.001 and p = 0.029), the lowest relative cerebral blood flow (0.63, p < 0.001), and the lowest rate of anterograde and retrograde collaterals (19%, p < 0.001; 66%, p = 0.002). The anterograde collaterals were associated with higher relative cerebral blood volume (0.91 vs. 0.77; p = 0.024) and a higher rate of deep cerebral microbleeds (48 vs. 21%; p = 0.028), whereas retrograde collaterals were associated with higher systolic and diastolic blood pressure (p = 0.031 and 0.020), smaller initial infarction volume (0.81 vs. 1.34 ml, p = 0.031), and a higher rate of lobar cerebral microbleeds (30 vs. 0%; p = 0.013). Both anterograde and retrograde collaterals may play a critical role in maintaining cerebral perfusion and can have an impact on patient clinical outcomes. Further studies are warranted to verify these findings and to investigate effective treatments.
Highlights
Evident recent small subcortical infarctions (SSI), commonly called lacunar infarcts, account for around one quarter of all cases of ischemic stroke and are one of the neuroimaging features of small vessel disease (SVD) [1]
A total of 385 patients with suspected stroke who underwent magnetic resonance imaging (MRI) studies within 24 h of symptom onset were evaluated in the current study
Anterograde and retrograde collaterals may play a critical role in maintaining cerebral perfusion, while perfusion compromise was closely associated with the devel‐ opment of early neurological deterioration (END) and final infarct size
Summary
Evident recent small subcortical infarctions (SSI), commonly called lacunar infarcts, account for around one quarter of all cases of ischemic stroke and are one of the neuroimaging features of small vessel disease (SVD) [1]. Recent SSIs are associated with the occlusion of penetrating arteries from different pathologies of SVD, including cer‐ ebral amyloid angiopathy and hypertensive arteriopathy [2]. There are other pathologies including embolism, microatheroma, and branch atheromatous disease (BAD) [3, 4]. BAD is caused by occlusion or stenosis at the origin of the large caliber penetrating arteries due to microatheromas or junctional plaques [5]. Lacunar infarction was thought to be caused by the occlusion of a terminal penetrating artery, with‐ out collateral circulation and the occurrence of penumbra [6, 7]. Previous studies of postmortem human brain revealed anastomoses of the major perforators and
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