Lenticulostriate artery combined with neuroimaging markers of cerebral small vessel disease differentiate the pathogenesis of recent subcortical infarction

Abstract

Recent subcortical infarction (RSI) in the lenticulostriate artery (LSA) territory with a non-stenotic middle cerebral artery is a heterogeneous entity. We aimed to investigate the role of LSA combined with neuroimaging markers of cerebral small vessel disease (CSVD) in differentiating the pathogenic subtypes of RSI by whole-brain vessel-wall magnetic resonance imaging (WB-VWI). Fifty-two RSI patients without relevant middle cerebral artery (MCA) stenosis on magnetic resonance angiography were prospectively enrolled. RSI was dichotomized as branch atheromatous disease (BAD; a culprit plaque located adjacent to the LSA origin) (n = 34) and CSVD-related lacunar infarction (CSVD-related LI; without plaque or plaque located distal to the LSA origin) (n = 18). Logistic regression analysis showed lacunes (odds ratio [OR] 9.68, 95% confidence interval [CI] 1.71–54.72; P = 0.010) and smaller number of LSA branches (OR 0.59, 95% CI 0.36–0.96; P = 0.034) were associated with of BAD, whereas severe deep white matter hyperintensities (DWMH) (OR 0.11, 95% CI 0.02–0.71; P = 0.021) was associated with CSVD-related LI. In conclusion, the LSA branches combined with lacunes and severe DWMH may delineate subtypes of SSI. The WB-VWI technique could be a credible tool for delineating the heterogeneous entity of SSI in the LSA territory.

Impaired dynamic cerebral autoregulation is associated with the severity of neuroimaging features of cerebral small vessel disease

“… 25 , 26 Until recently, the specific pathological mechanisms underlying CSVD still remained largely unknown, in part because of the lack of effective methods that can technically visualize or image small vessels in vivo. 4 , 25 Although the advances in neuroimaging have provided novel information in CSVD including detailed evaluation of the vessel wall, atherosclerotic plaques within intracranial arteries, 27 , 28 white matter integrity, WMH shape, and the fraction of free water in the drainage area, 29 , 30 , 31 there have been few researches investigating the dynamic vasculature's function of small vessels, such as dCA.…”

Macular Microvasculature Is Associated With Total Cerebral Small Vessel Disease Burden in Recent Single Subcortical Infarction

“…Diffusion-weighted imaging (DWI), three-dimensional time-of-flight MRA (3D-TOF-MRA), susceptibility-weighted image (SWI), and conventional Tl-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR) images were obtained as shown in Figure 1 . The detailed parameters of the imaging sequences have been well described in our previous study (Jiang et al, 2021 ).…”

“…Diffusion-weighted imaging (DWI), threedimensional time-of-flight MRA (3D-TOF-MRA), susceptibilityweighted image (SWI), and conventional Tl-weighted, T2weighted, fluid-attenuated inversion recovery (FLAIR) images were obtained as shown in Figure 1. The detailed parameters of the imaging sequences have been well described in our previous study (Jiang et al, 2021). All MR images were reviewed and analyzed with commercial software (OsiriX MD, Pixmeo SARL, Bernex, Switzerland) by two experienced readers (SJ and BW) blind to clinical information.…”

“…Recent single subcortical infarction (RSSI) formerly known as lacunar stroke accounts for a quarter of all ischemic strokes (Wardlaw, 2005 ); RSSI is usually caused by cerebral small vessel disease (CSVD) or steno-occlusion of a parent artery in the brain (Bladin and Berkovic, 1984 ; Jiang et al, 2020 , 2021 ). It has been suggested that RSSI patients have early neurological deteriorations which may lead to poor functional outcomes (Jiang et al, 2021 ). As such, timely and effective diagnostic approaches become critical, as treatment is more likely to be successful in the early phase of the disease.…”

Advances in Understanding the Pathogenesis of Lacunar Stroke: From Pathology and Pathophysiology to Neuroimaging

“…Recent studies have shown that whole-brain HR-MRI is feasible for assess-ing both large-vessel wall lesions and lenticulostriate vasculopathy in a single scan [6]. Using this novel imaging technique to evaluate the spatial relationship between middle cerebral artery (MCA) plaques and the origin of lenticulostriate arteries (LSAs), we appear to be the first group to categorize in vivo LS into BAD-related and CSVD-related LS [45], according to the original pathological descriptions (Fig. 4).…”