Can We Discriminate Stroke Mechanisms by Analyzing the Infarct Patterns in the Striatocapsular Region?

Lee, Kyung Bok; Oh, Hyung Geun; Roh, Hee-Tae; Ahn, Moo Young

doi:10.1159/000136652

Cited by 10 publications

(6 citation statements)

References 55 publications

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“…Since striatocapsular stroke is a rather rare type of ischemia, this also makes for a seemingly limited number of patients in our study. In this respect, this study is in line with other studies, which have studied stroke in this location and have reported on similar or smaller numbers of patients [9,24,25,26]. We cannot exclude that our results have at least been partially influenced by varying degrees of cerebral atrophy in our patients.…”

Section: Discussionsupporting

confidence: 91%

Chronic Small Vessel Disease Affects Clinical Outcome in Patients with Acute Striatocapsular Stroke

Held

Szabo²,

Bäzner³

et al. 2011

Cerebrovasc Dis

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Background: Recovery from stroke is presumed to be a function of a cerebral network. Chronic small vessel disease (SVD) has been shown to disrupt this network’s integrity and has been proposed as a predictor of poor outcome after stroke. We studied this hypothesis in patients with acute ischemic stroke of the striatocapsular region, an area of pronounced cortical and subcortical connectivity. Methods: We identified 62 patients with isolated striatocapsular stroke from our stroke registry. The standardized workup included clinical rating according to the modified Rankin Scale (mRS) and MRI, rated according to the Fazekas scale for the extent of SVD, ranging from grade 0 to III. MRS at admission, at discharge, and a short-term recovery parameter (the difference between mRS at admission and discharge) were correlated with the extent of SVD. Comorbidity was assessed with the Charlson comorbidity index (CCI). Results: SVD was graded 0 in 7%, I in 60%, II in 18%, and III in 16% of patients. The median mRS at discharge for the groups was 2, 1, 2 and 4, and the median recovery parameter was 2, 1, 1 and 0.5, respectively. The extent of SVD significantly correlated with both the mRS at discharge and the recovery parameter. While age was also a significant predictor of these outcome parameters, SVD severity was a significant predictor even after correction for age or CCI. Conclusions: SVD is a predictor of poor outcome and recovery in striatocapsular stroke, independent of age or comorbidity. Severe SVD disturbs the integrity of the cerebral network leading to aggravation of and poor recovery from neurological deficits.

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Section: Discussionsupporting

confidence: 91%

Chronic Small Vessel Disease Affects Clinical Outcome in Patients with Acute Striatocapsular Stroke

Held

Szabo²,

Bäzner³

et al. 2011

Cerebrovasc Dis

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“…To the best of our knowledge four major pathophysiologic processes have been proposed to cause iSCIs: (1) emboli to the proximal MCA (14, 42); (2) triangular-shaped carotid T occlusion allowing cortical supply (1); (3) extracranial carotid artery occlusion with either presumed emboli to the proximal MCA or hemodynamic alterations leading to deep territory infarction (4, 32); (4) atherosclerotic disease of the MCA with concomitant in situ thrombosis or other isolated MCA abnormalities (dissection, vasculitis) (4, 32, 43). Emboli to the MCA were found to result in iSCI if the peripheral tissue is preserved by an outstanding collateral system, and in combination with/or if the occlusion is of transient nature, which might be due to spontaneous thrombolysis, IV rtPA induced thrombolysis (23) or, as shown here, with ET.…”

Section: Discussionmentioning

confidence: 99%

Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal Middle Cerebral Artery Occlusions: Prevalence, Enabling Factors, and Clinical Outcome

Kaesmacher

Huber²,

Lehm

et al. 2017

Front. Neurol.

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BackgroundStriatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients.MethodsA retrospective analysis of 206 consecutive patients with an isolated MCA occlusion involving the lenticulostriate arteries and treated with ET was performed. Baseline patient and procedural characteristics and ischemic involvement of the striatocapsular and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were analyzed using multivariate logistic regression models. Prevalence of iSCI was assessed, and clinical course was determined with the rates of substantial neurological improvement and good functional short- and mid-term outcome (discharge/day 90 Modified Rankin Scale ≤2).ResultsiSCI was detected in 53 patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069–71.308] and good collaterals (aOR 2.100, 95% CI 1.119–3.944) were associated with iSCI. In successfully reperfused patients, TICI 3 was found to be an additional factor associated with iSCI (aOR 5.282, 1.759–15.859). Patients with iSCI had higher rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p < 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in general, had a more favorable outcome, considerable heterogeneity in outcome was observed.ConclusionHigh rates of successful reperfusion (TICI 2b/3) and in particular, complete reperfusion (TICI 3) are associated with iSCIs. The high prevalence of iSCI in successfully reperfused patients with good collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once considered a rare pattern of cerebral ischemia, is likely to become more prevalent with increases in endovascular stroke therapy. This may have implications for patient rehabilitation and pathophysiological analyses of ischemic damage confined to subcortical regions of the MCA territory.

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“…The coronal DWI of lesion distributions could indicate stroke causes and mechanisms in patients with striatocapsular infarctions [16]. However, this is the first study that demonstrates the clinical and imaging differences between the two patterns of the small deep infarcts in the subcortical area by coronal DWI.…”

Section: Discussionmentioning

confidence: 99%

Lesion Patterns of Small Deep Infarcts Have Different Clinical and Imaging Characteristics

et al. 2010

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Background: The mechanisms underlying small deep infarcts in the subcortical area are unknown. This study used coronal diffusion-weighted imaging (DWI) to investigate clinical and radiological findings in patients with small deep infarcts. Methods: This was a retrospective study of consecutively admitted patients with small deep infarcts in the subcortical area. We divided the patients into two groups as follows: (1) those with isolated lesion (IL) defined as an IL in the parenchyma by coronal DWI (group A), and (2) those with linear lesion (LL), defined as a LL extending to the basal surface on coronal DWI (group B). Results: A total of 86 patients were included in this study, with 43 patients in each group. Neurological decline and ipsilateral MCA stenosis were observed more frequently in group B than in group A. Fluid-attenuated inversion recovery (FLAIR) signals showed that white-matter hyperintensity was more severe in group A than in group B (p = 0.015). Conclusions: This study suggests that LL patterns of small deep infarcts may result in a higher rate of neurological decline and ipsilateral MCA stenosis than IL patterns.

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Can We Discriminate Stroke Mechanisms by Analyzing the Infarct Patterns in the Striatocapsular Region?

Cited by 10 publications

References 55 publications

Chronic Small Vessel Disease Affects Clinical Outcome in Patients with Acute Striatocapsular Stroke

Chronic Small Vessel Disease Affects Clinical Outcome in Patients with Acute Striatocapsular Stroke

Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal Middle Cerebral Artery Occlusions: Prevalence, Enabling Factors, and Clinical Outcome

Lesion Patterns of Small Deep Infarcts Have Different Clinical and Imaging Characteristics

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