Differential patterns of evolution in acute middle cerebral artery infarction with perfusion-diffusion mismatch

Atherosclerotic vs. cardioembolic occlusion

Hye Jin Kim, Sung Cheol Yun, Kyung-Hee Cho, A. Hyun Cho, Sun U. Kwon, Jong S. Kim, Dong Wha Kang

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: An acute perfusion-diffusion mismatch is known to be the strongest predictor of infarct growth. However, the differential patterns of clinical and radiological evolution according to stroke mechanism are unknown. Methods: The study retrospectively reviewed consecutive patients who had 1) acute middle cerebral artery (MCA) territory infarction, 2) diffusion- and perfusion-weighted imaging (DWI and PWI) and MR angiography within 24 h of onset, and follow-up DWI 5 days later, 3) stenosis (≥ 50%) or occlusion of MCA on baseline imaging, 4) a baseline PWI-DWI mismatch > 20%, and 5) either atherosclerotic MCA disease (MCAD) or cardioembolism (CE). National Institutes of Health Stroke Scale (NIHSS) scores and infarct volume at baseline and 5 days were obtained. Results: Of 90 patients, 52 had MCAD and 38 had CE. At baseline, CE group had more severe stroke (median NIHSS, 9 vs. 5; p = 0.001) and larger infarct volume (median 8.32 cc vs. 3.0 cc; p = 0.034) than MCAD group. During the 1-week period, CE group had larger infarct volume growth (median 12.85 cc vs. 3.02 cc; p = 0.004) than MCAD group, although clinical improvement based on NIHSS (baseline minus 5-day) tended to be higher for CE than MCAD group (median 3 vs. 1; p = 0.08). The correlation between infarct volume and NIHSS score was stronger in CE (r = 0.841) compared to MCAD (r = 0.582) group at 5-day. Conclusions: Substantial differences in the clinico-radiological evolution of acute ischemic stroke exist according to stroke mechanism. These data emphasize the importance of the stroke mechanism in the design of MRI-based acute stroke trials.

Original languageEnglish
Pages (from-to)93-98
Number of pages6
JournalJournal of the Neurological Sciences
Volume273
Issue number1-2
DOIs
Publication statusPublished - 2008 Oct 15
Externally publishedYes

Fingerprint

Middle Cerebral Artery Infarction
Perfusion
Stroke
National Institutes of Health (U.S.)
Cerebral Arterial Diseases
Perfusion Imaging
Middle Cerebral Artery
Growth
Angiography
Pathologic Constriction

Keywords

  • Cardioembolism
  • Intracranial atherosclerosis
  • Magnetic resonance imaging
  • Middle cerebral artery infarction
  • Perfusion-diffusion mismatch

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Differential patterns of evolution in acute middle cerebral artery infarction with perfusion-diffusion mismatch : Atherosclerotic vs. cardioembolic occlusion. / Kim, Hye Jin; Yun, Sung Cheol; Cho, Kyung-Hee; Cho, A. Hyun; Kwon, Sun U.; Kim, Jong S.; Kang, Dong Wha.

In: Journal of the Neurological Sciences, Vol. 273, No. 1-2, 15.10.2008, p. 93-98.

Research output: Contribution to journalArticle

Kim, Hye Jin ; Yun, Sung Cheol ; Cho, Kyung-Hee ; Cho, A. Hyun ; Kwon, Sun U. ; Kim, Jong S. ; Kang, Dong Wha. / Differential patterns of evolution in acute middle cerebral artery infarction with perfusion-diffusion mismatch : Atherosclerotic vs. cardioembolic occlusion. In: Journal of the Neurological Sciences. 2008 ; Vol. 273, No. 1-2. pp. 93-98.
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abstract = "Background: An acute perfusion-diffusion mismatch is known to be the strongest predictor of infarct growth. However, the differential patterns of clinical and radiological evolution according to stroke mechanism are unknown. Methods: The study retrospectively reviewed consecutive patients who had 1) acute middle cerebral artery (MCA) territory infarction, 2) diffusion- and perfusion-weighted imaging (DWI and PWI) and MR angiography within 24 h of onset, and follow-up DWI 5 days later, 3) stenosis (≥ 50{\%}) or occlusion of MCA on baseline imaging, 4) a baseline PWI-DWI mismatch > 20{\%}, and 5) either atherosclerotic MCA disease (MCAD) or cardioembolism (CE). National Institutes of Health Stroke Scale (NIHSS) scores and infarct volume at baseline and 5 days were obtained. Results: Of 90 patients, 52 had MCAD and 38 had CE. At baseline, CE group had more severe stroke (median NIHSS, 9 vs. 5; p = 0.001) and larger infarct volume (median 8.32 cc vs. 3.0 cc; p = 0.034) than MCAD group. During the 1-week period, CE group had larger infarct volume growth (median 12.85 cc vs. 3.02 cc; p = 0.004) than MCAD group, although clinical improvement based on NIHSS (baseline minus 5-day) tended to be higher for CE than MCAD group (median 3 vs. 1; p = 0.08). The correlation between infarct volume and NIHSS score was stronger in CE (r = 0.841) compared to MCAD (r = 0.582) group at 5-day. Conclusions: Substantial differences in the clinico-radiological evolution of acute ischemic stroke exist according to stroke mechanism. These data emphasize the importance of the stroke mechanism in the design of MRI-based acute stroke trials.",
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T2 - Atherosclerotic vs. cardioembolic occlusion

AU - Kim, Hye Jin

AU - Yun, Sung Cheol

AU - Cho, Kyung-Hee

AU - Cho, A. Hyun

AU - Kwon, Sun U.

AU - Kim, Jong S.

AU - Kang, Dong Wha

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AB - Background: An acute perfusion-diffusion mismatch is known to be the strongest predictor of infarct growth. However, the differential patterns of clinical and radiological evolution according to stroke mechanism are unknown. Methods: The study retrospectively reviewed consecutive patients who had 1) acute middle cerebral artery (MCA) territory infarction, 2) diffusion- and perfusion-weighted imaging (DWI and PWI) and MR angiography within 24 h of onset, and follow-up DWI 5 days later, 3) stenosis (≥ 50%) or occlusion of MCA on baseline imaging, 4) a baseline PWI-DWI mismatch > 20%, and 5) either atherosclerotic MCA disease (MCAD) or cardioembolism (CE). National Institutes of Health Stroke Scale (NIHSS) scores and infarct volume at baseline and 5 days were obtained. Results: Of 90 patients, 52 had MCAD and 38 had CE. At baseline, CE group had more severe stroke (median NIHSS, 9 vs. 5; p = 0.001) and larger infarct volume (median 8.32 cc vs. 3.0 cc; p = 0.034) than MCAD group. During the 1-week period, CE group had larger infarct volume growth (median 12.85 cc vs. 3.02 cc; p = 0.004) than MCAD group, although clinical improvement based on NIHSS (baseline minus 5-day) tended to be higher for CE than MCAD group (median 3 vs. 1; p = 0.08). The correlation between infarct volume and NIHSS score was stronger in CE (r = 0.841) compared to MCAD (r = 0.582) group at 5-day. Conclusions: Substantial differences in the clinico-radiological evolution of acute ischemic stroke exist according to stroke mechanism. These data emphasize the importance of the stroke mechanism in the design of MRI-based acute stroke trials.

KW - Cardioembolism

KW - Intracranial atherosclerosis

KW - Magnetic resonance imaging

KW - Middle cerebral artery infarction

KW - Perfusion-diffusion mismatch

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