Factors associated with two different stroke mechanisms in perforator infarctions regarding the shape of arteries

Abstract

Two diferent stroke mechanisms are involved in small vessel disease: branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD). We compared mechanisms of stroke in lenticulostriate arteries (LSA) vs. anterior pontine arteries (APA) and verifed factors associated with stroke mechanisms, including shape of middle cerebral artery (MCA) and basilar artery (BA). We retrospectively reviewed patients with acute ischemic stroke with penetrating artery territory confrmed by MRI. The mechanisms of stroke were categorized based on difusion-weighted imaging; BAD was defned as lesion larger than 10 mm in LSA and lesions involving basal pontine in APA. Other lesions were classifed as LD. The shapes of MCA and BA were classifed as straight, with one angle, or with two angles (U, C or S shape, respectively) using anterior–posterior view. The study included 221 patients. LD was more common in LSA infarcts, but BAD was more common in APA infarcts (p< 0.001). Low initial National Institutes of Health Stroke Scale [Adjusted Odds ratio (aOR)= 0.78; p< 0.001], absence of hyperlipidemia [aOR= 0.31; p= 0.002], previous statin use [aOR= 4.35; p= 0.028] LSA infarcts [reference=APA territory; aOR= 11.07; p< 0.001], and S-shaped vessels (reference = straight shaped vessels; aOR= 3.51; p= 0.004) were independently associated with LD. Angulations in the mother vessels may be more associated with true small vessel disease more with LD than BAD.