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. 2019;55(1):2.
doi: 10.1186/s41983-018-0045-8. Epub 2019 Jan 6.

Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction

Ahmed ElSadek  1 , Ahmed Gaber  1 , Hossam Afifi  1 , Sherin Farag  1 , Nouran Salaheldien  1
Affiliations

Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction

Ahmed ElSadek et al. Egypt J Neurol Psychiatr Neurosurg. 2019.

Abstract

Background: Brain perfusion is most likely to be impaired in border zone regions, and clearance of emboli will be most impaired in these regions of least blood flow. Severe occlusive disease of the internal carotid artery causes both embolization and decreased perfusion as well as some cardiac diseases that cause microembolization.

Objectives: To differentiate between hypoperfusion and microemboli as etiology of acute ischemic stroke in watershed zone.

Subject and methods: Fifty patients of acute ischemic stroke in watershed zones were recruited within 7 days from stroke onset. Methods used were transcranial Doppler (TCD) monitoring for the intracranial vessels to detect microembolic signals and magnetic resonance imaging (MRI) perfusion image to detect hypoperfusion signs.

Results: We detect embolic causes of watershed infarction (WSI) by using TCD with 61.1% sensitivity and 84.4% specificity and hypoperfusion causes of WSI by using MRI perfusion studies with 94.9% sensitivity and 54.5% specificity.

Conclusion: We detected the etiology of WSI, either embolic by using TCD or hypoperfusion by using MRI perfusion. The embolic causes of WSI usually cause external or mixed WSI, and hypoperfusion causes of WSI cause internal WSI.

Keywords: Hypoperfusion; Microemboli; Watershed zone infarction.

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Conflict of interest statement

The study was approved by Ain-Shams University Ethical Committee in January 2016. Written informed consent was obtained from the patients participating in the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Site of watershed infarction among cases. Among those 50 patients with acute WSI, 11 watershed infarction (WSI) (22%) were located externally (cortical), while 32 WSI (64%) were located internally (sub cortical) and seven WSI (14%) were mixed, i.e., both external and internal. WSI watershed infarction
Fig. 2
Fig. 2
Carotid duplex plaques. Among the 23 patients who had plaques by carotid duplex in their internal carotid artery, only one of them developed embolic WSI, while 16 patients developed hypoperfusion WSI and six patients developed mixed WSI. CD carotid duplex
See this image and copyright information in PMC

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