Evaluation of stroke topographic patterns and intracerebral hemodynamics in unilateral internal carotid artery stenosis or occlusion

Abstract

Objective To study the pathogenesis of cerebrovascular disorders by analysing the categories of cerebral infarct on magnetic resonance imaging (MRI) and intracerebral hemodynamics of patients with unilateral atherosclerotic internal carotid artery stenosis or occlusion (ICASO). Methods From August 2007 to May 2009, 87 ischemic stroke patients who were diagnosed arteriosclerosis ICASO by cerebral arteriography were investigated in Department of Neurology, the First Teaching Hospital of Xinjiang Medical University. Patients with potential cardiac sources of embolism were excluded. Cerebral infarct patterns were detected by MRI and the difference in cerebral hemodynamics were analysed by transcranial Doppler (TCD) among different imaging patterns. Results The infarct patterns in 87 patients were divided into 4 groups: territory infarcts (n = 30, 34.48%), subcortical infarcts (n = 27, 31.03%), border⁃ zone infarcts (n = 18, 20.69%), and disseminated small infarcts (n = 12, 13.79%). The distribution ratio of topographic patterns was significant in different degree of ICASO (χ2 = 7.156, P = 0.028). The topographic pattern was negatively correlated with the degree of ICASO (r = ⁃ 0.275, P = 0.010). Serious internal carotid artery (ICA) stenosis was associated with subcortical infarcts, border⁃zone infarcts (11/36, 30.56%, for all); territory infarcts showed a strong trend to appear mostly in patients with total ICA occulation (17/34, 50.00%). Seventy⁃five cases were involved in the hemodynamics analysis. In different groups of patient the mean flow velocity (Vm) and blood vessel pulsatility index (PI) of the affected side were all significantly lower than those of the intact side, while the lowest was shown in territory infarcts, and then in border⁃zone infarcts (P = 0.000, for all). Conclusion ICASO is mostly seen in patients with territory infarct, and hemodynamic disorder may occur in all infarct patterns. Therefore, cerebral infarct patterns and hemodynamic changes should be adequately considered for selecting optimal therapeutic and preventive measures. DOI：10.3969/j.issn.1672-6731.2011.03.01