Stroke Mechanisms

Abstract

Recent advances in neuroimaging technologies, such as diffusion weighted magnetic resonance imaging (MRI), perfusion weighted computed tomography (CT)/MRI, MR/CT angiography and Doppler ultrasonography allow us to determine the mechanisms of stroke and transient ischemic attack. In addition, high-resolution vessel wall MRI is nowadays increasingly used to understand the stroke mechanism in patients with intracranial atherosclerosis. Artery to artery embolism, hypoperfusion and the combination of the two are the important stroke mechanisms in patients with extracranial atherosclerosis. In addition to the above two, branch occlusion and in-situ thrombotic occlusion are important stroke mechanisms in patients with intracranial atherosclerosis. Branch occlusion leads to subcortical or brainstem infarcts indistinguishable from infarcts caused by small artery disease. In-situ thrombotic occlusion leads to larger territorial infarcts. However, whole territory infarcts are uncommon due to relatively well developed collateral circulation in these patients. The treatment strategy should be based on the correct understanding of the stroke mechanism in individual patients.

MRI of plaque characteristics and relationship with downstream perfusion and cerebral infarction in patients with symptomatic middle cerebral artery stenosis

“…Possible stroke mechanisms arising from ICAS includes branch occlusion, in situ thrombotic occlusion, artery‐to‐artery embolism, and hypoperfusion . However, these mechanisms often coexist and their pathophysiological features are interactive.…”

“…However, these mechanisms often coexist and their pathophysiological features are interactive. A vulnerable atherosclerotic plaque tends to produce plaque fissuring resulting in embolism to distal arteries, and may also lead to hypoperfused status in the distal area . Details on the correlation between intracranial vessel wall pathology and brain perfusion impairment remain elusive.…”

“…Possible stroke mechanisms arising from ICAS includes branch occlusion, in situ thrombotic occlusion, arteryto-artery embolism, and hypoperfusion. 12 However, these mechanisms often coexist and their pathophysiological features are interactive. A vulnerable atherosclerotic plaque tends to produce plaque fissuring resulting in embolism to distal arteries, and may also lead to hypoperfused status in the distal area.…”

“…A vulnerable atherosclerotic plaque tends to produce plaque fissuring resulting in embolism to distal arteries, and may also lead to hypoperfused status in the distal area. 12,13 Details on the correlation between intracranial vessel wall pathology and brain perfusion impairment remain elusive. Investigation of the relationship between plaque characteristics and downstream perfusion may facilitate understanding of the mechanisms underlying acute ischemic events in ICAS patients.…”

Sparganin A alleviates blood stasis syndrome and its key targets by molecular docking

“…Patients suffering from thrombotic occlusions induced by blood stasis are at a high risk of cardiovascular and cerebrovascular diseases such as acute myocardial infarction and ischemic stroke. 4,5 Thus, the need to optimize anti-thrombotic therapy is apparent. 6 Several approved anti-thrombotic drugs, such as warfarin and rivaroxaban, are targeting the complex biological process of thrombogenesis.…”