Single Subcortical Infarction and Atherosclerotic Plaques in the Middle Cerebral Artery

Abstract

Background and Purpose-Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its extension to the middle cerebral artery (MCA). We investigated the differences between pSSI and dSSI in terms of their clinical features, lesion size, and the frequency of MCA plaques detected by high-resolution MRI.

Branching Patterns Determine the Size of Single Subcortical Infarctions

“…Conversely, there were no differences in the indicators of atherosclerosis and the prevalence of MCA plaque between large and small SSIs. The prevalence of superiorly located plaque, which was reported to be more closely associated with SSI, 4 was not different, either. Our data are consistent with a previous report showing that the axial diameter of diffusion-weighted image-identified SSI was not significantly different between patients with or without relevant MCA disease 2 and support the hypothesis that the SSI size difference may be explained by variations in the branching pattern of perforators (Figure 2) rather than the pathogenic mechanism (large artery atherosclerosis versus small artery disease).…”

“…4 Briefly, patients admitted to the Asan Medical Center between July 2011 and August 2012 were prospectively enrolled if they (1) had a single infarct identified with the diffusion-weighted image in the lenticulostriate arterial territory (basal ganglia, corona radiata, and internal capsule); (2) did not have significant (>50% stenosis) and relevant MCA disease; (3) had no identified source of the embolism (eg, emboligenic cardiac disease or significant [≥50%] stenosis of the relevant artery); and (4) the MCA vessel and the infarcted area could be demonstrated by sagittal image of high-resolution MRI performed on the fifth day after the initial MRI. The study protocol was approved by the local institutional review board, and written informed consent was obtained from each patient.…”

“…4 The maximum diameter of the ischemic lesion was measured from the axial slice of the diffusion-weighted image. SSIs with a maximum diameter ≥20 mm were defined as large and others as small SSIs.…”

Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction

“…16 Yoon et al 17 and Chung et al 18 found that patients with pSSI had a higher prevalence of branch atheromatous plaque in MCA than those with dSSI …”

Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology

“…49 Similar studies have shown VW-MR imaging evidence of atherosclerotic plaque in the supplying artery of 52% of patients with MCA territory lacunar infarcts and 42% of patients with pontine infarcts, but normal MRA findings. 50,51 A VW-MR imaging study 52 that assessed the prevalence of MCA plaque both ipsilateral and contralateral to lenticulostriate territory infarcts in patients who had normal MRA findings found a similar prevalence (46% and 45%, respectively) bilaterally. This latter study did not report whether there was a difference in contrast enhancement between the plaques ipsilateral versus contralateral to the infarction.…”