The lesion patterns and mechanisms of ischemic stroke contralateral to the internal carotid artery occlusive disease.
BACKGROUND
In previous studies on unilateral internal carotid artery (ICA) occlusive disease, contralateral strokes have been ignored or excluded, probably because of their heterogeneity in etiology. The purpose of this study was to analyze the acute ischemic lesions contralateral to ICA occlusive disease and characterize the patterns and mechanisms of these strokes.


METHODS
Eight patients, who had an acute ischemic stroke contralateral to the ICA occlusion, were enrolled. All patients underwent routine clinical evaluation including history and physical examination, laboratory tests and magnetic resonance imaging (MRI). Both magnetic resonance angiography and digital subtraction cerebral angiography, along with carotid duplex sonography, transcranial Doppler sonography, electrocardiography and echocardiography were performed to confirm the stroke subtypes.


RESULTS
There were three distinctive stroke lesion patterns: (1) multiple infarcts in the border zone with or without a territorial lesion (4 patients), (2) multiple infarcts in the arterial territories sparing the border zone (2 patients), and (3) a small (<15 mm in MRI) single infarct in the internal border zone (2 patients). Overall, the patterns of ischemic lesions contralateral to the ICA occlusion were multiple and had a border zone distribution.


CONCLUSIONS
These results suggest that the pathogenic mechanisms underlying these strokes could be the synergistic effects of both the embolism and a low flow state.
Lee
Seung-Jae
SJ
Department of Neurology, The Catholic University of Korea, Seoul, Korea.
Lee
Kwang-Soo
KS
An
Jae-Young
JY
Kim
Woo-Jun
WJ
Kim
Yeong-In
YI
Kim
Bum-Soo
BS
Chung
So-Ryoung
SR
Kim
Joong-Seok
JS
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000473:pathology*