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. 2019 Dec 5;14(12):e0225906.
doi: 10.1371/journal.pone.0225906. eCollection 2019.

Clinical, imaging features and outcome in internal carotid artery versus middle cerebral artery disease

Changqing Zhang  1   2 , Yilong Wang  1   2 , Xingquan Zhao  1   2 , Liping Liu  1   2 , ChunXue Wang  1   2 , Zixiao Li  1   2 , Yuehua Pu  1   2 , Xinying Zou  1   2 , Yuesong Pan  2 , Yongjun Wang  1   2   3   4
Affiliations

Clinical, imaging features and outcome in internal carotid artery versus middle cerebral artery disease

Changqing Zhang et al. PLoS One. .

Abstract

Background: Only a very few studies had compared the differences in topographic patterns of cerebral infarcts between middle cerebral artery (MCA) and internal carotid artery (ICA) disease. Besides, the comparison of clinical features and outcomes between MCA and ICA disease had rarely been reported.

Objectives: To compare the clinical, imaging features and outcome of MCA versus ICA disease.

Methods: We prospectively enrolled 1172 patients with noncardiogenic ischemic stroke in ipsilateral ICA or MCA territory. Clinical, neuroradiologic and outcome of the two groups were compared in this observational cohort study.

Results: The ICA group more frequently presented with decreased alertness, gaze palsy, aphasia, and neglect than the MCA group at admission, and more often had higher National Institute of Health stroke scale score at admission and discharge. Meanwhile, the ICA group more frequently had multiple acute infarcts, watershed infarcts, territorial infarct, small cortical infarct, and responsible artery stenosis ≥70%. Whereas penetrating artery infarct and parent artery occluding penetrating artery was more often associated with MCA disease. The ICA group more frequently had inhospital complications of pneumonia and deep vein thrombosis, more often had disability at discharge, and had more recurrent ischemic stroke or transient ischemic attack in 1 Year. Multivariable logistic regression identified male (OR, 1.99; 95% CI, 1.30 to 3.05; P = 0.002), history of coronary heart disease (OR, 1.85; 95% CI, 1.03 to 3.32; P = 0.041), multiple acute infarcts (OR, 4.18; 95% CI, 2.07 to 8.45; P<0.0001), and territorial infarct (OR, 2.23; 95% CI, 1.52 to 3.27; P<0.0001) was more often associated with ICA territory disease.

Conclusions: The clinical, radiologic characteristics and outcome are distinctively different between ICA and MCA disease. Compared to MCA disease, ICA disease has more serious clinical and radiologic manifestation, and poorer outcome.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Topographical Distribution of Acute Ischemic Stroke in Internal Carotid Artery (ICA) or Middle Cerebral Artery (MCA) Territory.
A. Single acute infarct in left lenticulostriate artery of MCA territory, without obvious stenosis of left MCA. Small artery occlusion was the most possible etiologic subtype. B. A single acute infarct in right lenticulostriate artery territory, with obvious stenosis in M1 segment of RMCA. Large artery atherosclerosis (LAA) and parent artery occluding penetrating artery was the etiologic subtype and most possible stroke mechanism. C. Multiple acute infarcts (including internal watershed infarcts, cortical watershed infarcts, and small cortical infarct) in right MCA territory, with obvious stenosis in M1 segment of right MCA. The etiologic subtype was considered LAA. D. Single acute infarct in left anterior choroidal artery of ICA territory, with obvious stenosis in C7 segment of left ICA. LAA and parent artery occluding penetrating artery was considered as the etiologic subtype and most possible stroke mechanism. E. Multiple acute infarcts (including territorial infarct and penetrating artery infarct) in left ICA territory with occlusion of left ICA. The etiologic subtype was considered LAA.
Fig 2
Fig 2. Flow chart of patients enrollment.
See this image and copyright information in PMC

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