Clinical Researches
Clinical, imaging features and long-term outcomes in isolated anterior cerebral artery territory infarction: comparison of atherosclerotic stroke and non-atherosclerotic stroke
Shuanggen Zhu, Hongbing Chen, Shujin Tang, Wenjin Shang, Aiwu Zhang, Wusheng Zhu
Published 2017-10-28
Cite as Int J Cerebrovasc Dis, 2017, 25(10): 885-893. DOI: 10.3760/cma.j.issn.1673-4165.2017.10.003
Abstract
ObjectiveTo investigate clinical, imaging features, and long-term outcomes in patients with isolated anterior cerebral artery (ACA) territory infarction due to ACA atherosclerosis, and compare with isolated ACA territory infarction due to other etiologies.
MethodsThe consecutive patients with acute isolated ACA territory infarction confirmed by diffusion-weighted imaging were enrolled prospectively. According to their stroke etiology, they were divided into ACA atherosclerotic stroke and non-ACA atherosclerotic stroke. The infarction patterns were classified as single infarction including perforating artery infarction (PAI), small branch infarction (SBI) and cortical branch infarction (CBI), and multiple infarctions (a combination of PAI, SBI or CBI). The clinical, imaging features and long-term outcomes were compared between the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group.
ResultsA total of 86 patients (47 males) were enrolled, ages ranging from 39 to 88 years (mean 67.5±12.5 years). There were 56 patients in the ACA atherosclerotic stroke group, and 30 patients in the non-ACA atherosclerotic stroke group (12 carotid atherosclerosis, 6 cardioembolism, 2 internal carotid artery dissection, 10 undetermined etiology). The proportions of females (53.6% vs. 30.0%; P=0.043), progressive onset of stroke (58.9% vs. 20.0%; P=0.001), SBI alone (21.4% vs. 3.3%; P=0.029) and infarction involving small branches (80.4% vs. 46.7%; P=0.001) in the ACA atherosclerotic stroke group were higher than those in the non-ACA atherosclerotic stroke group, and CBI alone (17.9% vs. 55.3%, P=0.001) was lower. The follow-up times in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 29.8±16.5 months and 30.4±18.5 months, respectively (P=0.534). Five-year cumulative incidence of adverse events (stroke, cardiovascular events and death) in the ACA atherosclerotic stroke group and the non-ACA atherosclerotic stroke group were 36.3% and 69.9% respectively (log rank test, P=0.021).
ConclusionsACA atherosclerosis is the common etiology for isolated ACA territory infarction. The isolated ACA territory infarction due to ACA atherosclerosis had distinctive infarction patterns and a lower long-term incidence of adverse events compared with those due to non-ACA atherosclerosis.
Key words:
Stroke; Brain Ischemia; Infarction, Anterior Cerebral Artery; Intracranial Arteriosclerosis; Magnetic Resonance Imaging; Magnetic Resonance Angiography; Prognosis; Recurrence
Contributor Information
Shuanggen Zhu
Department of Neurology, the People's Hospital of Longhua District, Shenzhen 518109, China
Hongbing Chen
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Shujin Tang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Wenjin Shang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Aiwu Zhang
Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Wusheng Zhu
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
