Subtypes of anterior circulation large artery occlusions with acute brain ischemic stroke

Abstract

Anterior circulation large artery occlusion (Ac-LAo) related acute ischemic stroke (AiS) is particularly common in clinics in China. We retrospectively analyzed 787 consecutively hospitalized AIS patients with AC-LAO in Hebei Province, China. AC-LAO was defined as a complete occlusion of at least one intracranial internal carotid artery (icA) or middle cerebral artery (McA) based on computed tomography or magnetic resonance angiography. Among eight subtypes of Ac-LAo, unilateral McA occlusion is the most common one (49.8%, n = 392), while bilateral ICA/unilateral MCA occlusion is the least (0.3%, n = 2). Compared with unilateral MCA and unilateral ICA occlusion, patients with tandem ICA/MCA and bilateral ICA/MCA occlusion had poor outcomes after suffering AIS. Age (OR 1.022; 95%CI, 1.007 to 1.036) was an independent risk factor for single artery progressed to multiple artery occlusion, while ApoA1 (OR 0.453; 95% CI, 0.235 to 0.953) was a protective factor. Patients with unilateral MCA occlusion were prone to artery-to-artery embolism infarction subtype, unilateral icA occlusion group were the most vulnerable to hypoperfusion/impaired emboli clearance subtype. Our results suggested various AC-LAO subtypes have different clinical characteristics and prognosis and were prone to different subtypes of infarction. Customized preventive measures based on AC-LAO subtypes may be more targeted preventions of stroke recurrences for AiS patients and could improve their prognoses.Anterior circulation large artery occlusion (AC-LAO) is the most common cause of ischemic strokes 1,2 , especially in Chinese population 3 . For the treatment of those patients, thrombolytic therapy has a time window, and endovascular intervention treatment requires advanced surgical equipment and intensive care. Due to the large differences in medical conditions and levels across China, endovascular intervention treatment is available only in major stroke centers in cities, which means it cannot be applied to all patients with acute infarction, especially in rural areas 4-6 . Previous study showed intravenous thrombolysis and endovascular intervention treatments may not be effective in most patients with high clot burden LAO, and the resulting emboli may cause a worse prognosis 7 . Thus, there is still no treatment much more effective for patients with LAO suffering acute ischemic stroke (AIS) currently. By reviewing the literature, we found that most studies focusing on single unilateral middle cerebral artery (MCA), unilateral internal carotid artery (ICA), or tandem ICA/MCA occlusion, showing that a thrombus in the more proximal intracranial vasculature were more likely to have a poor outcome [8][9][10] . However, in clinical work we found that there are some other types of AC-LAO, such as unilateral and/or bilateral MCA combining unilateral and/or bilateral ICA. Whether different infarction subtypes are related with different types of occlusions or whether the prognosis worsens with the degree of artery occlusion have not been studied in depth u...

Effect of transverse sinus variation on the clinical outcomes of atherosclerotic anterior circulation infarction

“…LAA-type anterior circulation infarction is affected by a combination of genetic and environmental factors, and there are many studies on its pathogenesis and pathological process, but research on the contributors of LAA-type anterior circulation infarction is not conclusive. In the present study, consistent with the results of previous studies (11,12), the possible risk factors for the formation of LAAtype anterior circulation infarction were being male (62.7%), hypertension (60%), a history of stroke (46.7%), a NIHSS score of 5-15 (40%), an ASPECT score >7 (40%), diabetes mellitus (38.7%), a history of smoking (33.3%), a mRS score with a mean value in the moderate to high range, a relatively high percentage of these above risk factors, and mean values of serumtotalcholesterol (TC), glutamic acid (GLU), Uric acid(UA), and D-dipolymer (D-Di) higher than normal. In relation to the effects of TC, GLU, UA, D-Di, hypertension, diabetes, and smoking on blood vessels, research has shown that (13) TC abnormalities lead to vascular endothelial cell damage, which in turn induces vascular inflammatory responses, promotes foam cell formation and thus TC is involved in atherosclerosis by promoting the formation of foam cells.…”

“…of the LAA type. Consistent with the findings of Zhang and others (12,18), the NIHSS score is an independent predictor of adverse clinical outcomes in patients with LAA anterior circulation infarction, and most patients with LAA anterior circulation infarction have large vessel stenosis, and due to stenosis and hypoperfusion, platelet clots, and fibrin accumulate in the arterial wall, leading to thrombosis. In addition high stroke-related scores are more likely to lead to large vessel occlusion, which in turn aggravates clinical symptoms.…”

Machine Learning-Based Model for Predicting Incidence and Severity of Acute Ischemic Stroke in Anterior Circulation Large Vessel Occlusion

“…Furthermore, we found that stroke severity at admission was greater in the multiple AC-LAO patients than in unilateral MCA occlusion or unilateral ICA occlusion patients. This is consistent with a previously published study of patients with AC-LVO AIS, which showed that high NIHSS was associated with multiple AC-LAO (28).…”

Epidemiology of acute stroke presentations to an emergency ambulance service

“…[14][15][16][17][18] The most common sites of anterior circulation occlusion are unilateral middle cerebral artery (MCA) (49.8%), unilateral internal carotid artery (ICA) (24.1%) and tandem ICA/MCA (12.7%);. 19 In the posterior circulation most occlusive events occurred in the vertebral arteries followed by the basilar artery and posterior cerebral artery. 20 Paramedic assessment will be the first opportunity for large vessel occlusion (LVO) to be suspected and for patients to be triaged to a site capable of diagnosing and treating LVO with endovascular thrombectomy.…”