Open AccessStroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native S outh A sian P akistanis
Author(s) -
Khan Maria,
Rasheed Asif,
Hashmi Saman,
Zaidi Moazzam,
Murtaza Muhammad,
Akhtar Saba,
Bansari Lajpat,
Shah Nabi,
Samuel Maria,
Raza Sadaf,
Khan Umer Rais,
Ahmed Bilal,
Ahmed Bilawal,
Ahmed Naveeduddin,
Ara Jamal,
Ahsan Tasnim,
Munir S. M.,
Ali Shoukat,
Mehmood Khalid,
Makki Karim Ullah,
Ahmed Muhammad Masroor,
Sheikh Niaz,
Memon Abdul Rauf,
Frossard Philippe M.,
Kamal Ayeesha Kamran
Publication year - 2013
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/j.1747-4949.2012.00878.x
Subject(s) - medicine , leukoaraiosis , asymptomatic , stroke (engine) , middle cerebral artery , stenosis , cardiology , magnetic resonance angiography , transcranial doppler , magnetic resonance imaging , radiology , disease , concomitant , hyperintensity , ischemia , mechanical engineering , engineering
Background There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native S outh A sian P akistanis. Methods Men and women aged ≥18 years with acute stroke presenting to four tertiary care hospitals in K arachi, P akistan were screened using magnetic resonance angiography/transcranial D oppler scans. Trial of ORG 10172 in A cute S troke T reatment criteria were applied to identify strokes from intracranial atherosclerotic disease. Results We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89·0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42·2% (87/206) followed by border‐zone infarcts (52/206, 25·2%). Increasing degrees of stenosis correlated with the development of both cortical and border‐zone strokes ( P = 0·002). Important associated findings were frequent atrophy (166/230, 72·2%), silent brain infarcts (66/230, 28%) and a marked lack of severe leukoaraiosis identified in only 68/230 (29·6%). A total of 1870 arteries were studied individually. Middle cerebral artery was the symptomatic stroke vessel in half, presenting with complete occlusion in 66%. Evidence of biological disease, symptomatic or asymptomatic was identified in 753 (40·2%) vessels of which 543 (72%) were significantly (>50%) stenosed at presentation. Conclusion Intracranial atherosclerotic disease is a diffuse process in P akistani south A sians, with involvement of multiple vessels in addition to the symptomatic vessel. The middle cerebral artery is the most frequent symptomatic vessel presenting with cortical embolic infarcts. There is a relative lack of leukoaraiosis. Concomitant atrophy, silent brain infarcts and recent ischaemia in the symptomatic territory are all frequently associated findings.