Diffusion-weighted imaging in stroke attributable to internal carotid artery dissection: the significance of vessel patency.
OBJECTIVE
In stroke attributable to spontaneous dissection of the internal carotid artery (sICAD), arterial patency may influence the pattern and extent of cerebral ischemia.


METHODS
In 40 consecutive patients with stroke caused by sICAD, we compared the number, size and pattern of cerebral diffusion-weighted imaging lesions between patients with stenotic sICAD (n=15) and occlusive sICAD (n=25).


RESULTS
Patients with stenotic sICAD had more ischemic lesions (median 5, interquartile range 1 to 10) than patients with occlusive sICAD (2, 1 to 3; P=0.014). Lesion diameters were larger in occlusive sICAD (62, 50 to 99 mm) than in stenotic sICAD (25, 10 to 50 mm; P=0.007). Border-zone infarction occurred only in stenotic sICAD (7/15, 47%). Most patients with occlusive sICAD had territorial infarcts (22/25, 88%).


CONCLUSIONS
In stroke attributable to sICAD, diffusion-weighted imaging characteristics may be influenced by the patency of the carotid artery. Differences in the pathogenesis of cerebral ischemia might exist between patients with stenotic and those with occlusive sICAD.
Bonati
Leo H
LH
Wetzel
Stephan G
SG
Gandjour
Joubin
J
Baumgartner
Ralf W
RW
Lyrer
Philippe A
PA
Engelter
Stefan T
ST
D000328:Adult; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology / Q000502:physiology; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology* / Q000473:pathology*