title: Two different clinical entities of small vessel occlusion in TOAST classification.
abstract: BACKGROUND
  Small deep infarcts might be classified into 2 types: lacunar and branchatheromatous infarcts. However, since their initial description, small deep infarcts were still regarded as the same category of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, small vessel occlusion (SVO). We hypothesized that the 2 types of small deep infarcts would be distinct clinical entities. This study was conducted to investigate the clinical characteristics in the 2 groups of patients according to lesion pattern and combined atherosclerotic diseases.
  
  
  METHODS
  We included patients with small deep infarcts in the subcortical area. The patients were divided into 2 groups: (1) island lesions and (2) linear lesions on coronal diffusion weighted imaging. The status of the relevant artery was categorized as no stenosis, non-significant (<50% of luminal narrowing) and significant (≥ 50% of luminal narrowing). We compared the clinical and imaging characteristics of two lesion types according to various arterial status.
  
  
  RESULTS
  This study analyzed a total of 248 patients. Independent factors for island lesions on coronal DWI were male, severe leukoaraiosis, microbleeds, abnormal glycated hemoglobin (HbA1C), and abnormal estimated glomerular filtration ratio (eGFR) adjusted by age, sex, and initial National Institutes of Health Stroke Scale. In addition, in patients without significant relevant arterial stenosis, island lesion patterns were more frequently associated with severe periventricular white matter hyperintensity, diabetes mellitus, abnormal eGFR and abnormal HbA1C than linear lesion patterns.
  
  
  CONCLUSIONS
  This study demonstrated that SVO of TOAST classifications had different imaging and clinical characteristics according to the lesion patterns of coronal imaging. It suggests that two types of SVO should be regarded as the different categories of stroke classification.
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Dong-Eun
authors.initials: DE
authors.lastname: Kim
authors.forename: Min-Ji
authors.initials: MJ
authors.lastname: Choi
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Jane
authors.initials: J
authors.lastname: Chang
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.forename: Kang-Ho
authors.initials: KH
authors.lastname: Choi
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Oh
authors.forename: Seung-Han
authors.initials: SH
authors.lastname: Lee
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications; D002536:Cerebral Arteries / Q000473:pathology; D002544:Cerebral Infarction / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000145:classification* / Q000150:complications; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D058226:Plaque, Atherosclerotic / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000145:classification* / Q000209:etiology; D059409:Stroke, Lacunar / Q000473:pathology
keywords: Branch-atheromatous infarct; Early neurological deterioration; Lacunar infarction; Small deep infarcts; Small vessel occlusion