title: Mechanism of acute ischemic stroke in patients with severe middle cerebral artery atherosclerotic disease.
abstract: BACKGROUND
  Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Although the pathogenesis of cerebral infarct in ICAD has been reported from autopsy series, the mechanism of stroke is not well known. This study used baseline perfusion imaging and diffusion-weighted imaging (DWI) or computerized tomography (CT) imaging to help identify the mechanism of stroke in ICAD involving the middle cerebral artery (MCA).
  
  
  METHODS
  We retrospectively reviewed baseline CT or magnetic resonance (MR) perfusion studies and diffusion-weighted MR imaging or CT scans in patients with severe symptomatic MCA stenosis. Perfusion scans were classified according to stage of perfusion deficit, and the acute stroke patterns were categorized as borderzone, cortical, or perforating artery infarcts according to DWI or noncontrast CT.
  
  
  RESULTS
  Fifteen patients were included in this analysis. All 15 patients had some type of borderzone infarct. Six had borderzone infarct only, 4 had borderzone and cortical infarcts, and 5 had borderzone, cortical, and perforating artery infarcts. Thirteen of the 15 patients had baseline perfusion deficits.
  
  
  CONCLUSIONS
  In patients with severe MCA ICAD, the mechanism of stroke is multifactorial, but hemodynamic insufficiency plays a significant role. This finding is important in selecting a subgroup of patients who may benefit from revascularization.
authors.affiliation: Department of Neurology and Neurosciences, Weill Cornell Medical College, New York, New York.
authors.forename: Jordan S
authors.initials: JS
authors.lastname: Dubow
authors.affiliation: Department of Neurology and Neurosciences, Weill Cornell Medical College, New York, New York.
authors.forename: Elliott
authors.initials: E
authors.lastname: Salamon
authors.affiliation: Departments of Neurosurgery and Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Edward
authors.initials: E
authors.lastname: Greenberg
authors.affiliation: Departments of Neurosurgery and Radiology, Weill Cornell Medical College, New York, New York. Electronic address: atp9002@med.cornell.edu.
authors.forename: Athos
authors.initials: A
authors.lastname: Patsalides
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D006439:Hemodynamics; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: Acute cerebral infarct; computerized tomography and magnetic resonance imaging; pathophysiology