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Clinical significance of common-stem lenticulostriate arteries in patients with internal watershed infarction

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Abstract

Background

A common-stem origin of lenticulostriate arteries (CS-LSAs) is an anatomical variation that supplies a moderate to large section of the basal ganglia. We hypothesized that CS-LSAs with a patent orifice are located at distal positions of the acute-occluded middle cerebral artery (MCA) and that the blood flow of CS-LSAs is supplied by pail arterial anastomoses and results in hypoperfusion of CS-LSAs, similar to a deep watershed (DWS) infarction.

Objective

Our study evaluated the possibility of CS-LSAs in patients with DWS infarction and MCA occlusion and also assessed the safety of endovascular therapy (ET) in these patients.

Methods

A cohort of consecutive patients with DWS infarction and MCA occlusion and in whom full recanalization via ET was achieved were identified. Patients were divided into two groups based on the presence of CS-LSAs observed during ET. In addition, radiological and clinical data were retrospectively analyzed.

Results

Thirty-three patients were included, and CS-LSAs were observed in 48.5% (16/33) of patients. The possibility (72.2%, 13/18) of CS-LSAs was high in patients with DWS infarction companied with basal ganglia infarction. A good clinical outcome was similar in patients with CS-LSAs and basal ganglia infarction and in patients without CS-LSAs and basal ganglia infarction (69.2% vs. 81.8%, P = 0.649).

Conclusions

The possibility of CS-LSAs was 48.5% in patients with DWS infarction and MCA occlusion, and the revascularization procedure was safe and feasible in these patients despite the moderate-to-large basal ganglia infarction.

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Abbreviations

LSAs:

Lenticulostriate arteries

CS-LSAs:

Common-stem LSAs

MCA:

Middle cerebral artery

ICA:

Internal carotid artery

ET:

Endovascular therapy

DWS:

Deep watershed

NIHSS:

National Institutes of Health Stroke Scale

mRS:

Modified Rankin Scale

FVH:

Fluid-attenuated inversion recovery vascular hyperintensities

CWS:

Cortical watershed

mTICI:

Modified Thrombolysis in Cerebral Infarction

ACG:

American Society of Interventional and Therapeutic Neuroradiology collateral grading

TOAST:

Trial of Org 10172 in Acute Stroke Treatment

sICH:

Symptomatic intracranial hemorrhage

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Acknowledgments

We thank teams from American Journal Expert (https://secure.aje.com/cn/researcher/), for editing the English text of a draft of this manuscript.

Funding

This research received grant from Joint Funds for the innovation of science and Technology, Fujian province (Grant number: 2018J01207).

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Authors and Affiliations

  1. Department of Neurology, Zhangzhou affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China

    Wen -huo Chen, Ting-yu Yi, Yan-min Wu, Mei-fang Zhang, Ding-lai Lin, Xiao-hui Lin & Zhi-nan Pan

  2. Department of Radiology, Zhangzhou affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China

    A-lai Zhan, Yi-min Li & Yan-yu Lu

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  1. Wen -huo Chen
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Correspondence to Ting-yu Yi.

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Implication of patient care

1. There is a moderate chance of common-stem LSAs (CS-LSAs) in progressive ischemic stroke patients with deep watershed (DWS) infarction and middle cerebral artery (MCA) occlusion.

2. The mechanism of basal ganglia infarction was hypoperfusion in these types of patients.

3. The recanalization procedure was feasible in these patients.

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Chen, W.h., Yi, Ty., Zhan, Al. et al. Clinical significance of common-stem lenticulostriate arteries in patients with internal watershed infarction. Neurol Sci 40, 2303–2309 (2019). https://doi.org/10.1007/s10072-019-03953-w

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  • DOI: https://doi.org/10.1007/s10072-019-03953-w

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