Comparison of Clinical and Neuroradiological Characteristics between Internal Carotid Artery and Middle Cerebral Artery Occlusive Diseases

ABSTRACT

BACKGROUND: The relative importance of embolic mechanisms as opposed to hemodynamic factor in the pathogenesis of ischemic strokes associated with atherosclerotic middle cerebral artery (MCA) or internal carotid artery (ICA) disease remains unresolved. We conducted the present study to identify the differences of clinicoradiological patterns between MCA or ICA diseases. METHODS: We defined atherosclerotic disease of MCA or ICA as > 50% stenotic lesions or ulcerative plaques. We divided the patients into groups of MCA and ICA diseases, and analyzed clinical, laboratory, and neuroradiological data. RESULTS: Among the 620 consecutive patients with acute ischemic strokes, 84 (12.9%) patients met the criteria for atherosclerotic MCA or ICA disease 54 patients with MCA disease and 30 patients with ICA disease. The mean age was younger in patients with MCA than ICA disease (p=0.003). MCA disease clinically more frequently presented with lacunar syndrome (p=0.001). ICA disease more frequently presented with total anterior circulation infarct and had higher initial NIHSS scores than MCA disease (p=0.004 and 0.003, respectively). While whole MCA territorial infarcts were common in ICA disease, deep perforator infarcts were more significantly caused by MCA disease (p< 0.05). MR topographic patterns showed difference between MCA and ICA diseases according to the degree of stenosis (p< 0.05). Cortical dots were significantly accompanied by superficial perforator infarcts than internal borderzone infarcts (p=0.017). CONCLUSIONS: Our present study suggests that clinical and neuroradiological representations might be different between MCA and ICA diseases, which might reflect difference of underlying pathogenesis.