Open AccessAcute insular infarction: Early outcomes of minor stroke with proximal artery occlusion
Author(s) -
Sung Kil Min,
JoonTae Kim,
Kyung Tae Kang,
MinJi Choi,
Hana Yoon,
Yuki Shinohara,
Michael H. Lev,
Jeffrey L. Saver,
Ki-Hyun Cho
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0229836
Subject(s) - medicine , lesion , stroke (engine) , infarction , insular cortex , occlusion , middle cerebral artery , cardiology , surgery , myocardial infarction , ischemia , mechanical engineering , engineering , psychiatry
Background and purpose We hypothesized that admission insular infarcts could be associated with early neurological deterioration (END) in acute minor stroke with large vessel occlusion. Methods Using acute and follow-up diffusion-weighted imaging (DWI), we assessed insular involvement including the percent insular ribbon infarction (PIRI) scores and follow-up lesion patterns in acute minor stroke (NIHSS ≤5) with MCA/ICA occlusion. Follow-up lesion patterns were classified as swelling, new lesions, or infarct growth. END was defined as any increase in the NIHSS score. Results Among 166 patients (age: 66±12 y, 60.8% male), 82 (49.4%) had insular lesions on baseline DWI, and 64 (38.6%) had PIRI scores ≥2. On follow-up DWI, infarct growths, new lesions, and swelling were observed in 34.9%, 69.9%, and 29.5% of patients. Infarct growths were significantly more frequent in patients with insular infarcts (43.9%), especially those with a PIRI score of 2 (54.8%), than in patients without insular infarcts (p = 0.02). While END was not significantly different in patients with and without insular lesions, insular lesions were independently associated with infarct growths (OR 2.18, 95% CI 1.12–4.26, p = 0.02) and END due to infarct growth (OR 2.54, 95% CI 1.12–5.76, p = 0.03), particularly in those with PIRI scores ≥2. Conclusion In acute minor stroke with MCA/ICA occlusion, insular lesions on admission DWI, especially in patients with PIRI scores ≥2, were more likely to exhibit infarct growth and END due to infarct growth. This finding may help identify patients with higher risks of clinical worsening following acute minor stroke with large vessel occlusion.