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(Stroke. 2008;39:483.)
© 2008 American Heart Association, Inc.

Research Letters

Diffusion-Weighted Imaging in Stroke Attributable to Internal Carotid Artery Dissection

The Significance of Vessel Patency

Leo H. Bonati, MD; Stephan G. Wetzel, MD; Joubin Gandjour, MD; Ralf W. Baumgartner, MD; Philippe A. Lyrer, MD Stefan T. Engelter, MD

From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland.

Correspondence to Stefan T. Engelter, MD, Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail EngelterS{at}uhbs.ch

Abstract

Background and Purpose— In stroke attributable to spontaneous dissection of the internal carotid artery (sICAD), arterial patency may influence the pattern and extent of cerebral ischemia.

Methods— In 40 consecutive patients with stroke caused by sICAD, we compared the number, size and pattern of cerebral diffusion-weighted imaging lesions between patients with stenotic sICAD (n=15) and occlusive sICAD (n=25).

Results— Patients with stenotic sICAD had more ischemic lesions (median 5, interquartile range 1 to 10) than patients with occlusive sICAD (2, 1 to 3; P=0.014). Lesion diameters were larger in occlusive sICAD (62, 50 to 99 mm) than in stenotic sICAD (25, 10 to 50 mm; P=0.007). Border-zone infarction occurred only in stenotic sICAD (7/15, 47%). Most patients with occlusive sICAD had territorial infarcts (22/25, 88%).

Conclusions— In stroke attributable to sICAD, diffusion-weighted imaging characteristics may be influenced by the patency of the carotid artery. Differences in the pathogenesis of cerebral ischemia might exist between patients with stenotic and those with occlusive sICAD.

Key Words: DWI • internal carotid artery dissection • occlusion • stenosis • stroke