| Part I:The associating of anterior temporal artery with infarct patterns and functional outcome in acute atherosclerotic M1-middle cerebral artery occlusionObjective:We aim to investigate the correlation between presence of anterior temporal artery (ATA), the first major branch of middle cerebral artery (MCA), on conventional angiography and infarct patterns and clinical outcome in patients with acute atherosclerotic Ml-MCA occlusion.Methods:Consecutive patients with acute atherosclerotic Ml-MCA occlusion from Nanjing Stroke Registry Program (NSRP) between January 2007 and December 2012 were included in this study. All patients underwent MRI followed by conventional angiography. From their data, we analyzed baseline characteristics, infarction patterns, DWI-ASPECTS, and collateral circulation. The correlation of ATA presence and good clinical outcome, modified Rankin Scale (mRS) score at 3 months was also calculated.Results:In 98 patients meeting entry criteria, the presence of ATA was found in 44 patients. Patients with ATA present were found to have less hypertension (44.4% vs 65.9%, P=0.034), lower baseline National Institutes of Health Stroke Scale (NIHSS) (median score 7.0 vs 8.5, P=0.043), more small infarcts in perforating artery territory (22.7% vs 5.6%, P=0.013), and a higher number of DWI-ASPECTS≥7 (65.9% vs 44.4%, P=0.034). The presence of ATA correlated well with high DWI-ASPECTS (R =0.223, P=0.027) and distal Ml occlusion (R=0.376, P< 0.001). At 3 months, 50/98 patients (51.0%) had a good clinical outcome. The good outcome group had a lower baseline NIHSS score (median,5 vs 11.5, P< 0.001), higher prevalence rate of ATA (62.0% vs 27.1%, P=0.001), more patients with ASPECTS≥7 (78.0 vs 29.2, P< 0.001), and more single BZ territory lesions (20.0% vs 4.8%, P=0.099) on DWI than the group with bad outcome. Binary logistic regression analysis showed an adjusted odds ratio of 4.45 for a good outcome in patients with ATA presence (95% CI 1.52 to 13.03.P=0.007).Conclusion:The presence of ATA is associated withmore small infarcts in perforating artery territory and favorablefunctional outcome in patients with acute atherosclerotic Ml-MCA occlusion.PartⅡ:Early Magnetic Resonance Imaging Predicts Early Neurological Deterioration in Acute Middle Cerebral Artery Minor StrokeBackground:Early neurological deterioration (END) is an important factor associated with worse clinical outcome in minor strokes. Early magnetic resonance imaging (MRI) findings can provide better sensitivity to delineate stroke pathophysiology and have diagnostic value associated with causative mechanisms. The aim of this study was to investigate the relationship between early MRI finding and the presence of END in minor stroke patients with lesions in the middle cerebral artery (MCA) territory.Methods:Consecutive MCA minor stroke patients who were admitted to our center within 24 hours of symptom onset were included in this study. All patients underwent MRI within 24 hours of admission. We analyzed baseline characteristics, infarction patterns, and treatment algorithms. The correlation between early MRI findings and END, defined as an increase in the National Institutes of Health Stroke Scale score by more than 2 points during 72 hours after admission, was also determined.Results:Across 211 patients meeting entry criteria between January 2010 and December 2013, internal border-zone (IBZ) infarcts on early MRI scan were observed in 23 of 65 patients with END (35.4%) and in 18 of 146 patients without END (12.3%, P<.001). Patients with IBZ infarcts were found to have more hyperlipidemia (19.5% vs 7.6%, P=0.023), less perforating artery infarcts (22.0% vs 80.6%, P< 0.001), more pial artery infarcts (24.4% vs 11.2%. P=0.027), more cortical border-zone infarcts (31.7% vs 15.9%, P=0.020) and more ipsilateral large arterial stenosis (70.7% vs 45.3%, P=0.003). Logistic regression analysis revealed that age (odds ratio,1.03: 95% confidence interval,1.00-1.05; P=0.041), more ipsilateral large arterial stenosis (OR,2.01; 95%CI,1.05-3.85; P=0.036) IBZ infarct (OR,2.50; 95% CI, 1.09-5.74; P=0.031) was independently associated with END after adjustment for other potentianl confounders.Conclusions:Early MRI patterns of IBZ infarction are associated with END in minor stroke patients with acute infarcts of the MCA territory.Part Ⅲ:DWI Lesion Patterns Predict Outcome in atherosclerotic middle cerebral artery Stroke Patients with ThrombolysisBackground:Infarct patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory, yet it remains unclear whether such imaging prognostic factors are related to response to intravenous thrombolysis. The aim of this study is to investigate the response to intravenous thrombolysis in acute MCA ischemic strokes with respect to infarction patterns.Methods:Consecutive acute ischemic stroke cases of the MCA territory treated over a seven year period were retrospectively analyzed. All acute MCA stroke patients underwent magnetic resonance imaging scan before intravenous thrombolytic therapy were included. Diffusion-weighted imaging (DWI) lesions were divided into six patterns (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts). Lesion volumes were measured by a dedicated imaging processing software. Favorable outcome was defined as modified Rankin Scale of 0 to 2 at 90 days.Results:Among the 172 patients included in our study,75 (43.6%) patients were observed to have territorial infarct patterns or other deep infarct patterns. These patients also had higher baseline NIHSS score (P<0.001), a higher proportion of major cerebral artery occlusions (P<0.001) and larger infarct volume (P<0.001). Favorable outcome (mRS 0-2) was achieved in 89 patients (51.7%). Univariate analysis revealed that age (61.8±15.4 vs 72.5±15.7, P< 0.001), NIHSS score[9.0 (4.0-15.5) vs 16.0 (11.0-20.0), P< 0.001], major cerebral artery occlusions (30.3% vs 51.8%, P=0.004), infarct volume[17.1 (5.0-46.2) vs 35.3 (8.3-73.2), P=0.029] and specific infarct patterns (29.2% vs 59.0%, P< 0.001) were associated with favorable functional outcome. Logistic regression analysis revealed that age (odds ratio,1.05; 95% confidence interval,1.02-1.07; P<0.001),NIHSSscore (OR,1.06; 95% CI, 1.00-1.12; P=0.045)and specific infarct patterns group (OR,0.40; 95% CI,0.16-0.99; P=0.047) were independently associated with unfavorable outcome after adjustment for other potentianl confounders.Conclusions:Specific infarct patterns.including territorial infarct and other deep infarct pattern, predict differential response to intravenous thrombolysis therapy in acute MCA stroke patients. |
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