Little Association between Intracranial Arterial Stenosis and Lacunar Stroke

Abstract

Atheromatous middle cerebral artery (MCA) stenosis could cause lacunar stroke by occluding lenticulostriate artery origins, but atheroma is common, and previous studies lacked suitable controls. We aimed to determine if intracranial atheroma was more common in lacunar than in cortical ischaemic stroke. We recruited patients with lacunar stroke and controls with mild cortical stroke, confirmed the stroke subtype with magnetic resonance imaging and used transcranial Doppler ultrasound imaging to record flow velocity and focal stenoses in the basal intracranial arteries 1 month after stroke. We compared ipsi- and contralateral MCA mean flow velocities between stroke subtypes and tested for associations using linear mixed models. Amongst 67 lacunar and 67 mild cortical strokes, mean age 64 and 67 years, respectively, we found no difference in MCA mean flow velocity between cortical and lacunar patients. Increasing age and white matter lesion scores were independently associated with lower MCA flow velocities (0.2 cms^–1 fall in velocity per year increase in age, p = 0.045; 3.75 cms^–1 fall in flow velocity per point increase in white matter lesion score, p = 0.004). We found no intracranial arterial stenoses. MCA atheromatous stenosis is unlikely to be a common cause of lacunar stroke in white populations. Falling velocities with increasing white matter lesion scores may reflect progressive brain tissue loss leaving less tissue to supply.

The Relationship between Neurological Worsening and Lesion Patterns in Patients with Acute Middle Cerebral Artery Stenosis

“…Several studies have suggested that MCA stenosis obliterating the mouth of deep perforating arteries is one of the mechanisms of perforating artery infarcts [21,22,23,24]. On the other hand, Wardlaw et al [25] reported that intracranial large artery atheroma is unlikely to be a common cause of lacunar infarcts. Cho et al [26] did not find the difference between infarct size and MCA disease in patients with acute deep subcortical MCA territory infarcts.…”

A relationship between the integrated assessment of magnetic resonance imaging markers for cerebral small vessel disease and the clinical and functional status in the acute period of ischemic stroke

“…В то же время часть выявленных взаимосвязей (с фракцией вы-броса и степенью стеноза) указывает на важную роль гипо-перфузии в патогенезе ЦБМС, что соотносится с недавно предложенной I. Masafumi и Y. Yamamoto концепцией, сог-ласно которой важным звеном в патогенезе ЦБМС являет-ся дисфункция гематоэнцефалического барьера, которая вызывается, в частности, гипоперфузией на фоне атеро-склероза крупных церебральных артерий [11]. Тем не менее существует противоположная точка зрения, в соответствии с которой старение и лейкоареоз сопровождаются потерей вещества мозга, что приводит к уменьшению потребности в его перфузии [12].…”

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

“…6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke. [7][8][9] Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic injury.…”