Factors associated with two different stroke mechanisms in perforator infarctions regarding the shape of arteries

Abstract

Two different stroke mechanisms are involved in small vessel disease: branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD). We compared mechanisms of stroke in lenticulostriate arteries (LSA) vs. anterior pontine arteries (APA) and verified factors associated with stroke mechanisms, including shape of middle cerebral artery (MCA) and basilar artery (BA). We retrospectively reviewed patients with acute ischemic stroke with penetrating artery territory confirmed by MRI. The mechanisms of stroke were categorized based on diffusion-weighted imaging; BAD was defined as lesion larger than 10 mm in LSA and lesions involving basal pontine in APA. Other lesions were classified as LD. The shapes of MCA and BA were classified as straight, with one angle, or with two angles (U, C or S shape, respectively) using anterior–posterior view. The study included 221 patients. LD was more common in LSA infarcts, but BAD was more common in APA infarcts (p < 0.001). Low initial National Institutes of Health Stroke Scale [Adjusted Odds ratio (aOR) = 0.78; p < 0.001], absence of hyperlipidemia [aOR = 0.31; p = 0.002], previous statin use [aOR = 4.35; p = 0.028] LSA infarcts [reference = APA territory; aOR = 11.07; p < 0.001], and S-shaped vessels (reference = straight shaped vessels; aOR = 3.51; p = 0.004) were independently associated with LD. Angulations in the mother vessels may be more associated with true small vessel disease more with LD than BAD.

Differential Vessel features according to the Pathophysiologic Type of Intracranial Atherosclerosis

“…We found no significant differences in the atherosclerotic and small vessel disease burden between different ICAS subtypes, supporting previous studies and our hypothesis that BAD is not a milder form of PAD but is caused by a different pathophysiological mechanism. 6 Furthermore, in terms of clinical characteristics, including vascular risk factors, BAD is more similar to PAD than to small artery disease, 8,9 and in our study, only BMI was significantly different among the clinical factors. Therefore, local vascular rather than systemic clinical factors may contribute to the different pathophysiological mechanisms of PAD and BAD.…”

“…5 BAD, which is a subcortical ischemic stroke caused by a parent artery atheroma occluding the orifice of a perforating artery, occurs primarily in the lenticulostriate and anterior pontine arteries. 8 A study using high-resolution magnetic resonance imaging (HR-MRI) reported different morphological features of plaques in PAD and BAD, 7 and another study observed an association between different plaque locations in the MCA. 9 These different plaque features and locations suggest that PAD and BAD have different pathophysiological mechanisms; however, few studies exist on the clinical and vascular factors that influence these pathophysiological mechanisms (Figure 1).…”