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Clinical determinants of infarct pattern subtypes in large vessel atherosclerotic stroke

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Abstract

Background

Although stroke from large vessel atherothromboembolism has a common pathogenesis, its topographic presentation is variable. Given the impact of cerebral infarct size and location on incident stroke magnitude and subsequent prognosis, we evaluated the determinants of cerebral infarct topography among patients with atherosclerotic stroke.

Methods

We analyzed data on 148 consecutive patients admitted over a 4-year period to a university medical center with acute ischemic stroke within the MCA distribution on DWI, presumed due to atherosclerosis. Based on the DWI data, we divided the patients into three stroke phenotypes: large cortical, small (< 1 cm in diameter) cortical, and deep pattern. Independent factors for each stroke phenotype were evaluated using logistic regression.

Results

After adjusting for covariates, premorbid statin use (OR, 3.05; 95 % CI, 1.40–6.65) and older age (OR, 1.05 per 1 year increase; 95 % CI, 1.02–1.08) were independently associated with the small cortical phenotypic pattern. In contrast, younger age (OR, 0.95 per 1 year increase; 95 % CI, 0.92–0.98), premorbid statin non-use (OR, 0.40; 95 % CI, 0.17–0.99), and higher levels of fasting s-glucose (OR, 1.01 per 1 mg/dl increase; 95 % CI, 1.00–1.02) and admission peripheral WBC counts (OR, 1.13 per 1 × 109 cells/L; 95 % CI, 1.00–1.27) were independently associated with the large cortical pattern. There was no relation between DWI patterns and LDL-cholesterol levels.

Conclusions

Age, premorbid statin use, s-glucose and WBC count predict atherosclerotic stroke phenotype. Further studies should examine whether modifying some of these factors may result in more favorable phenotypic patterns.

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Abbreviations

MCA:

middle cerebral artery

ICA:

internal carotid artery

DWI:

diffusion-weighted imaging

WBC:

white blood cell

LDL:

low-density lipoprotein

HDL:

high-density lipoprotein

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Author information

Authors and Affiliations

  1. UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA, 90095, USA

    Jeffrey L. Saver MD

  2. Dept. of Neurology, Samsung Medical Center, Seoul, South Korea

    Oh Young Bang MD, PhD

  3. Dept. of Neurology, UCLA Medical Center, Los Angeles, CA, USA

    Bruce Ovbiagele MD, David S. Liebeskind MD, Lucas Restrepo MD & Jeffrey L. Saver MD

  4. Dept. of Radiology, UCLA Medical Center, Los Angeles, CA, USA

    Sa Rah Yoon MD

Authors
  1. Oh Young Bang MD, PhD
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  2. Bruce Ovbiagele MD
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  3. David S. Liebeskind MD
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  4. Lucas Restrepo MD
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  5. Sa Rah Yoon MD
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  6. Jeffrey L. Saver MD
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Correspondence to Jeffrey L. Saver MD.

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Bang, O.Y., Ovbiagele, B., Liebeskind, D.S. et al. Clinical determinants of infarct pattern subtypes in large vessel atherosclerotic stroke. J Neurol 256, 591–599 (2009). https://doi.org/10.1007/s00415-009-0125-x

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  • DOI: https://doi.org/10.1007/s00415-009-0125-x

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