Abstract
Background and purpose
The etiologic diagnosis of intracranial arterial occlusion is sometimes challenging
because of the dynamic nature of acute stroke. We investigated whether short-term
follow-up vascular imaging adds additional information to the differential diagnosis
between intracranial atherosclerotic and embolic occlusion.
Methods
Acute ischemic stroke patients with symptomatic middle cerebral artery (MCA) occlusion
on MR angiography (MRA) within 24 h of symptom onset were included. Follow-up MRA was performed 5–7 days after stroke onset. Stroke subtypes were independently determined at baseline
and follow-up MRAs based on clinical, laboratory and imaging findings.
Results
In the 108 included patients, the most common etiologic subtype of initial stroke
was intracranial large artery atherosclerosis (ICLAA) in 70 patients, followed by
cardioembolism in 29 and other causes in 9. On follow-up MRA, 32 (29.6%) patients
showed either significant or complete recanalization. Of these, 10 had been originally
diagnosed with ICLAA, but were reclassified as a cryptogenic mechanism after follow-up
MRA. Multiple logistic regression analysis showed that the presence of coexisting
arterial atherosclerosis (odds ratio [OR], 6.91; 95% confidence interval [CI], 2.67–17.91;
p<0.001); the absence of large territorial infarction (OR, 4.06; 95% CI, 1.39–11.85;
p=0.010); and smoking (OR, 2.54; 95% CI, 1.028–6.29; p=0.043) were significantly associated with a final diagnosis of ICLAA.
Conclusion
In the absence of follow-up vascular imaging, a substantial proportion of patients
with intracranial middle cerebral arterial occlusion may be misdiagnosed as ICLAA.
Evaluation of early dynamic changes in intracranial middle cerebral arterial occlusion
may provide useful information for the differential diagnosis of intrinsic atherosclerosis
and embolic occlusion.
Keywords
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Article info
Publication history
Published online: August 29, 2011
Accepted:
August 2,
2011
Received in revised form:
July 20,
2011
Received:
April 27,
2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
