Small Artery Embolism In Cardiogenic Stroke: Clinical And Imaging Analysis

Objective:To investigate the occurrence of small artery(especially subcortical small artery) embolism in cardiogenic stroke and its risk factors.Methods:We prospectively registered the consecutive acute ischemic stroke patients who were admitted in Department of Neurology,the Second Affiliated Hospital,School of Medicine,Zhejiang University,PR China,from September 2008 to February 2009. According to the modified TOAST classification,stroke patients were divided into five groups;the incidence of risk factors of stroke,NIHSS,and mRS were compared between cardioembolism(Group A) and small artery disease associated stroke(SAD stroke)(Group B).The occurrences of the small embolic lesions in cardiogenic stroke were evaluated comprehensively.Results:There were significant differences in the two groups in age,serum C-reactive protein level,serum fibrinogen,serum D-dimer.The age and the level of C-reactive protein,fibrinogen,D-dimer of cardioembolism were significant higher than that of small artery disease.Scores of NIHSS and mRS were significantly higher in group A than in group B.In the 15 patients of cardioembolism who had received DWI examination,11 cases(73.3%) had small subcortical lesion,2 cases who had a single cortical lesion were located in the brain stem;6 cases had small cortex lesions,and 13.3%patients had a single small lesion.66.7%cases had lesions in the anterior circulation,53.3%had lesions more than 3cm in diameter.Conclusion:Cerebral small artery embolisms are very common in cardiogenic stroke, which includes cortical and subcortical small lesions,and the latter is more common. Subcortical small lesions always appear together other kinds of cerebral embolic lesions. Cardioembolism is more frequently located in the anterior circulation.More than half cardiogenic patients have a lesion of large diameter which are mostly located in the left cerebral hemisphere.Cardioembolism has a close relationship with infection and hyercoagulabale state.Cardiogenic stroke patients are more severe in handicap and neurologic impairment than the ones of small artery diseases.