Pathogenetic stroke subtypes and their diagnostic criteria in patients with ischemic heart disease and intracranial atherosclerosis: a clinical-morphological study

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Abstract

Introduction. An important objective of vascular neurology is to improve understanding of the pathogenetic subtypes of ischemic stroke and their diagnostic criteria, making it possible to perform targeted treatment and adequate prevention of cerebral circulation disorders.
Objective. To identify the pathogenetic stroke subtypes and to specify whether their differential diagnosis is possible in patients with ischemic heart disease (IHD) combined with intracranial atherosclerosis.
Materials and methods. The results of the morphological study and the findings of intravital examination of patients in 40 postmortem cases are compared.
Results. It is shown that the same forms of IHD (atrial fibrillation, myocardial infarction, or postinfarction cardiosclerosis) combined with intracranial atherosclerosis may result in stroke classified as belonging to different pathogenetic subtypes: cardiogenic embolic or hemodynamic stroke, with an almost identical incidence rate (51 and 49%, respectively). In at least 90% of cases, diagnosis of cardiogenic embolic strokes can be based on revealing the infarction outside the regions of the adjacent blood supply of cerebral arteries if a patient had the embolic form of IHD and did not have pronounced stenosis and embologenic atherosclerotic plaques on the ipsilateral side to the infarction. In at least 72% of cases, hemodynamic strokes were determined by the IHD-related hemodynamic factor that was responsible for the development of infarction in the zones of adjacent blood supply or lacunar stroke if there was pronounced ipsilateral stenosis. The hemorrhagic component in brain infarctions (38%) and asymptomatic embolism of the internal organs (46%) were found to be associated with cardiogenic and embolic strokes, as well as hemodynamic strokes with atypical localization and extent of infarction related to intracranial tandem stenosis.
Conclusion. The early risks of developing both cardiogenic embolic stroke and hemodynamic stroke were shown to be equal in patients with IHD and intracranial atherosclerosis. It has been proved that these stroke subtypes have distinctive features that enable differential diagnosis of these two diseases.

About the authors

Renat E. Ablyakimov

Research Center of Neurology

Email: anufriev@neurology.ru
Russian Federation, Moscow

Pavel L. Anufriev

Research Center of Neurology

Author for correspondence.
Email: anufriev@neurology.ru
Russian Federation, Moscow

Marine M. Tanashyan

Research Center of Neurology

Email: anufriev@neurology.ru
Russian Federation, Moscow

References

  1. Suslina Z.A., Gulevskaya T.S., Maksimova M.Yu., Morgunov V.A. Narusheniya mozgovogo krovoobrashсheniya: diagnostika, lechenie, profilaktika [Cerebrovascular disease: diagnosis, treatment, prevention]. Moscow. MEDpress-inform, 2016. 536 p. (In Russ.).
  2. Adams H.P.Jr., Bendixen B.H., Kappelle L.J. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41. doi: 10.1161/01.STR.24.1.35. PMID: 7678184.
  3. Amarenco P., Bogousslavsky J., Caplan L.R. et al. The ASCOD Phenotyping of Ischemic Stroke (Updated ASCO Phenotyping). Cerebrovasc. Dis. 2013; 36: 1–5. doi: 10.1159/000352050. PMID: 23899749.
  4. Ay H., Benner T., Arsava E.M. et al. A computerized algorithm for etiologic classification of ischemic stroke: The Causative Classification of Stroke System. Stroke 2007; 38: 2979–2984. doi: 10.1161/STROKEAHA.107.490896. PMID: 17901381.
  5. Bogousslavsky J., Van Melle G., Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988; 19 (9): 1083–1092. doi: 10.1161/01.STR.19.9.1083. PMID: 3413804.
  6. Chen P.-H., Shan G., Wang Y.-J., et al. Classifying Ischemic Stroke, from TOAST to CISS. CNS Neuroscience and Therapeutics 2012; 18; 452–456. doi: 10.1111/j.1755-5949.2011.00292.x. PMID: 22268862.
  7. Gao S., Wang Y.J., Xu A.D., et al. Chinese ischemic stroke subclassification. Front. Neurol. 2011; 2 (6): 1–5. doi: 10.3389/fneur.2011.00006. PMID: 21427797.
  8. Suslina Z.A., Varakin Yu.Ya. Klinicheskoe rukovodstvo po rannej diagnostike, lecheniyu i profilaktike sosudistyh zabolevanij golovnogo mozga [Clinical guide to early diagnostics, treatment and prevention of cerebrovascular diseases]. Moscow, MEDpress-inform. 2015. 440 p. (In Russ.).
  9. Shevchenko Yu.L., Odinak M.M., Kuznecov A.N., Erofeev A.A. Kardiogennyj i angiogennyj cerebral’nyj embolicheskij insul’t (fiziologicheskie mehanizmy i klinicheskie projavleniya) [Cardiogenic and angiogenic cerebral embolic stroke (physiological mechanisms and clinical implications)]. Moscow. GEOTAR-Media, 2006. 272 p. (In Russ.).
  10. Arboix A., Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Current Cardiol. Rev. 2010; 6: 150–161. doi: 10.2174/157340310791658730. PMID: 21804774.
  11. Di Tullio M.R., Homma S. Mechanisms of cardioembolic stroke. Curr. Cardiol. Rep. 2002; 4: 141–148. doi: 10.1007/s11886-002-0027-3. PMID: 11827638.
  12. Ferro J.M. Cardioembolic stroke: an update. Lancet Neurol. 2003; 2: 177–188. doi: 10.1097/01.SMJ.0000063471.13035.85. PMID: 12849239.
  13. Murtagh B., Smalling R.W. Cardioembolic stroke. Curr. Atherosclr. Rep. 2006; 8: 310–316. doi: 10.1007/s11883-006-0009-9. PMID: 16822397.
  14. Ois A., Cuadrado-Godia E., Rodríguez-Campello А. et al. Relevance of stroke subtype in vascular risk prediction. Neurology 2013; 81: 575-580. doi: 10.1212/WNL.0b013e31829e6f37. PMID: 23825174.
  15. Bolotova T.A., Anufriev P.L. [Diagnostic criteria for ischemic strokes of various pathogenic subtypes in patients with atherosclerosis and arterial hypertension]. Annaly Klinicheskoy i Eksperimental’noy Nevrologii [Annals of clinical and experimental neurology]. 2009; 3 (4), 4–10. (In Russ.).
  16. Evdokimenko A.N., Gulevskaya T.S. [Single and multiple cerebral infarctions caused by atherosclerosis: morphology and pathogenesis]. Annaly Klinicheskoy i Eksperimental’noy Nevrologii [Annals of clinical and experimental neurology]. 2011; 5 (1): 11–18. (In Russ.).
  17. Tanashyan M.M., Lagoda O.V., Gulevskaya T.S. et al. [Progressing cerebral atherosclerosis: clinical, biochemical and morphological aspects]. Annaly Klinicheskoy i Eksperimental’noy Nevrologii [Annals of clinical and experimental neurology]. 2013; 7 (4): 4–9. (In Russ.).
  18. Caplan L.R., Wong K.S., Gao S., Hennerici M.G. Is hypoperfusion an important cause of strokes? If so, how? Cerebrovasc. Dis. 2006; 21: 145–153. doi: 10.1159/000090791. PMID: 16401883.
  19. Klijn C.J.M., Kappelle L.J. Haemodynamic stroke: clinical features, prognosis, and management. Lancet Neurol. 2010; 9: 1008–1017. doi: 10.1016/S1474-4422(10)70185-X. PMID: 20864053.
  20. Bogiatzi C., Wannarong T., McLeod A.I. et al. SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes. Neuroepidemiology 2014; 42: 243–251. doi: 10.1159/000362417. PMID: 24862944.
  21. Touboul P.J., Elbaz A., Koller C. et al. Common carotid artery intima-media thickness and ischemic stroke subtypes: the GENIC case-control study. The GENIC Investigators. Circulation 2000; 102 (3): 313–318. doi: 10.1161/01.CIR.102.3.313. PMID: 10899095.

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Copyright (c) 2016 Ablyakimov R.E., Anufriev P.L., Tanashyan M.M.

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