Infarct patterns in atherosclerotic middle cerebral artery versus internal carotid artery disease.
OBJECTIVE
To compare clinical and radiologic characteristics of atherosclerotic middle cerebral artery (MCA) vs internal carotid artery (ICA) disease.


METHODS
The authors defined atherosclerotic MCA and ICA disease as >50% symptomatic stenosis or occlusion without significant ICA and MCA stenosis on MR angiography. Patients with potential cardiac sources of embolism were excluded. The authors analyzed clinical, laboratory, and neuroradiologic data of the two groups.


RESULTS
Among the 920 consecutive patients with acute ischemic strokes, 112 met the criteria for atherosclerotic MCA and 71 met the criteria for ICA disease. Clinically, the MCA group more frequently presented with lacunar syndrome (p = 0.001), whereas the ICA group more often presented with total anterior circulation infarct and had higher initial NIH Stroke Scale scores than the MCA group (all p < 0.001). Whereas deep perforator and internal border-zone infarcts were associated with MCA disease (p < 0.001 and 0.012), territorial infarcts and superficial perforator infarcts were associated with ICA disease (p < 0.001 and p = 0.009). The topographic patterns with respect to the degree of stenosis were also significantly different between the two groups.


CONCLUSIONS
The clinical and radiologic stroke patterns were distinctively different between atherosclerotic MCA and ICA disease, suggesting different underlying pathogeneses.
Lee
P H
PH
Department of Neurology, School of Medicine, Ajou University, Suwon, Korea.
Oh
S-H
SH
Bang
O Y
OY
Joo
S-Y
SY
Joo
I S
IS
Huh
K
K
D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis*; D002343:Carotid Artery, Internal / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D015588:Observer Variation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D014654:Vascular Patency