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

Abstract

Introduction.An important objective of vascular neurology is toimprove understanding of the pathogenetic subtypes of ischemicstroke and their diagnostic criteria, making it possible to performtargeted treatment and adequate prevention of cerebral circulationdisorders. Objective.To identify the pathogenetic stroke subtypes and tospecify whether their differential diagnosis is possible in patientswith ischemic heart disease (IHD) combined with intracranialatherosclerosis. Materials and methods.The results of the morphological studyand the findings of intravital examination of patients in 40 postmortemcases 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 strokeclassified as belonging to different pathogenetic subtypes: cardiogenicembolic or hemodynamic stroke, with an almost identicalincidence rate (51 and 49%, respectively). In at least 90%of cases, diagnosis of cardiogenic embolic strokes can be basedon revealing the infarction outside the regions of the adjacentblood supply of cerebral arteries if a patient had the embolicform of IHD and did not have pronounced stenosis and embologenicatherosclerotic plaques on the ipsilateral side to theinfarction. In at least 72% of cases, hemodynamic strokes weredetermined by the IHD-related hemodynamic factor that wasresponsible for the development of infarction in the zones ofadjacent blood supply or lacunar stroke if there was pronouncedipsilateral stenosis. The hemorrhagic component in brain infarctions(38%) and asymptomatic embolism of the internalorgans (46%) were found to be associated with cardiogenic andembolic strokes, as well as hemodynamic strokes with atypicallocalization and extent of infarction related to intracranial tandemstenosis. Conclusion.The early risks of developing both cardiogenic embolicstroke and hemodynamic stroke were shown to be equal inpatients with IHD and intracranial atherosclerosis. It has beenproved that these stroke subtypes have distinctive features thatenable differential diagnosis of these two diseases.

Keywords

• brain infarction
• ischemic stroke
• coronary heart disease
• atherosclerosis of cerebral arteries