Yonsei Med J.  2017 Jan;58(1):123-130. 10.3349/ymj.2017.58.1.123.

Lenticulostriate Artery Involvement is Predictive of Poor Outcomes in Superficial Middle Cerebral Artery Territory Infarction

• Lee K
• Kim EH
• Song D
• Kim YD
• Nam HS
• Lee HS
• Heo JH

• KMID: 2374197
• DOI: http://doi.org/10.3349/ymj.2017.58.1.123

Abstract

PURPOSE
Patients with superficial middle cerebral artery (MCA) territory infarction may have concomitant lenticulostriate artery (LSA) territory infarction. We investigated the mechanisms thereof and the outcomes of patients with superficial MCA territory infarction according to the presence or absence of LSA involvement.
MATERIALS AND METHODS
Consecutive patients with first-ever infarction in the unilateral superficial MCA territory were included in this study. They were divided into the superficial MCA only (SM) group and the superficial MCA plus LSA (SM+L) group.
RESULTS
Of the 398 patients, 84 patients (21.1%) had LSA involvement (SM+L group). The SM+L group more frequently had significant stenosis of the proximal MCA or carotid artery and high-risk cardioembolic sources. Stroke severity and outcomes were remarkably different between the groups. The SM+L group showed more severe neurologic deficits (National Institute of Health Stroke Scale score 10.8±7.1 vs. 4.0±5.0, p<0.001) and larger infarct in the superficial MCA territory (40.8±62.6 cm³ vs. 10.8±21.8 cm³, p<0.001) than the SM group. A poor functional outcome (mRS >2) at 3 months was more common in the SM+L group (64.3% vs. 15.9%, p<0.001). During a mean follow-up of 26 months, 67 patients died. All-cause (hazard ratio, 2.246) and stroke (hazard ratio, 9.193) mortalities were higher in the SM+L group than the SM group. In multivariate analyses, LSA involvement was an independent predictor of poor functional outcomes and stroke mortality.
CONCLUSION
LSA territory involvement is predictive of poor long-term outcomes in patients with superficial MCA territory infarction.

Keyword

Lenticulostriate artery; middle cerebral artery; cerebral infarction; prognosis; mortality

MeSH Terms

Carotid Stenosis/mortality/pathology
Constriction, Pathologic/pathology
Female
Humans
Infarction, Middle Cerebral Artery/mortality/*pathology
Male
Middle Cerebral Artery/*pathology
Multivariate Analysis
Severity of Illness Index
Stroke/mortality/pathology

Figure

• 

  Fig. 1 Comparison of mean NIHSS scores for each item between the groups. Scores for all NIHSS items except that for limb ataxia are significantly higher in the SM+L group. NIHSS, National Institute of Health Stroke Scale; SM, superficial middle cerebral artery only; SM+L, superficial middle cerebral artery plus lenticulostriate artery; LOC, loss of consciousness.

• 

  Fig. 2 Modified Rankin Scale at 3 months of symptom onset. Numbers are percentages (%). SM, superficial middle cerebral artery only; SM+L, superficial middle cerebral artery plus lenticulostriate artery.

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  Fig. 3 Kaplan-Meier curve for all-cause mortality (A) and stroke mortality (B). SM, superficial middle cerebral artery only; SM+L, superficial middle cerebral artery plus lenticulostriate artery.

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