Diffusion-Weighted Imaging in Stroke Attributable to Internal Carotid Artery Dissection : The Significance of Vessel Patency

• Published in: Stroke (1970) 2008-02, Vol.39 (2), p.483-485
• Main Authors: BONATI, Leo H, WETZEL, Stephan G, GANDJOUR, Joubin, BAUMGARTNER, Ralf W, LYRER, Philippe A, ENGELTER, Stefan T
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Brain Infarction - etiology; Brain Infarction - pathology; Carotid Artery, Internal - pathology; Carotid Artery, Internal - physiology; Carotid Artery, Internal, Dissection - complications; Carotid Artery, Internal, Dissection - pathology; Carotid Stenosis - complications; Carotid Stenosis - pathology; Cerebrovascular Circulation; Diffusion Magnetic Resonance Imaging; Female; Humans; Male; Medical sciences; Middle Aged; Neurology; Neurosurgery; Skull, brain, vascular surgery; Stroke - etiology; Stroke - pathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.107.496760

In stroke attributable to spontaneous dissection of the internal carotid artery (sICAD), arterial patency may influence the pattern and extent of cerebral ischemia. In 40 consecutive patients with stroke caused by sICAD, we compared the number, size and pattern of cerebral diffusion-weighted imaging lesions between patients with stenotic sICAD (n=15) and occlusive sICAD (n=25). Patients with stenotic sICAD had more ischemic lesions (median 5, interquartile range 1 to 10) than patients with occlusive sICAD (2, 1 to 3; P=0.014). Lesion diameters were larger in occlusive sICAD (62, 50 to 99 mm) than in stenotic sICAD (25, 10 to 50 mm; P=0.007). Border-zone infarction occurred only in stenotic sICAD (7/15, 47%). Most patients with occlusive sICAD had territorial infarcts (22/25, 88%). In stroke attributable to sICAD, diffusion-weighted imaging characteristics may be influenced by the patency of the carotid artery. Differences in the pathogenesis of cerebral ischemia might exist between patients with stenotic and those with occlusive sICAD.