Clinical and neuroradiological analysis of thrombotic and embolic cerebral infarction.

Differences in Clinical Features and Computed Tomographic Findings between Embolic and Non-Embolic Acute Ischemic Stroke: A Quantitative Differential Diagnosis.

“…Angiographic features ofembolic stroke are as follows: 1) an abrupt arterial occlusion, 2) occlusion at the sitejust prior to arterial branching in the distal end of the ICA or MCAstem, or occlusion in the MCAbranch, 3) absent or insufficient collateral circulation via the circle ofWillis or leptomeningeal anastomoses, 4) frequent reopening phenomenonof the occluded vessel, and 5) frequent multiple arterial occlusions due to breakdown of the embolus (2-8, 26). The main radiographic features of thrombotic or hemodynamicstroke are as follows: 1) a gadual obstruction with thrombus formation on the atheromatous plaque, 2) an occlusion at the origin ofICA or MCAstem, 3) influence of hemodynamicfactors such as grade of stenosis and/or collateral circulations via the circle ofWillis or leptomeningeal anastomoses (3,4,29).…”

“…Criteria for the angiographic diagnosis of NEby CAGincluded an occlusion of a major cerebral artery associated with atherosclerotic changes (wall irregularity), i.e. stump or tapering occlusion at the origin of internal carotid artery (ICA) or the proximal stem (origin) of the middle cerebral artery (MCA) (3,29). Occlusion of the MCAbranch with marked arterial wall irregularity was also considered as atherosclerotic in nature (29).…”

“…Initial CTs were performed on the average 4.0 days after onset of EM, and 4.1 days in NE. Infarct index was also calculated as a ratio of the hypodense area to the homolateral hemispheric area, and expressed in percent (3). These analyses were performed without CAG information.…”

“…embolic, thrombotic, or hemodynamic (1). Differentiation of embolic stroke from thrombotic or hemodynamicstroke is particularly important (2)(3)(4)(5) , because the strategies for management during the acute stage differ, based on the mechanisms of stroke onset rather than clinical subtypes. Subcategorization based on pathophysiological mechanisms can be more valuable in hyperacute ischemic stroke (e.g.…”

“…However, differentiation of the pathophysiological mechanisms during the acute stage is often difficult. Clinical diagnostic criteria for embolic stroke have been proposed, mainly for cardioembolic stroke (1)(2)(3)(4)(5)(6)(7), whereas the characteristics, severity and treatment appear somewhat different between cardiogenic and artery-to-artery brain embolism (8). There are no useful clinical diagnostic criteria for nonembolic stroke, which has different mechanisms, thrombotic and hemodynamic,however, there have been a few reports suggesting differences in the clinical features according to pathogenetic and pathophysiological mechanisms among embolic and thrombotic or hemodynamic stroke (2)(3)(4)(5).…”