# The Correlations of Clinical Outcomes and Vascular Morphology With Infarct Patterns in Middle Cerebral Arterial Occlusion

## TL;DR

This study finds that the shape of a blood vessel in the brain affects stroke outcomes, with twisted or long vessels linked to worse results.

## Contribution

The study identifies specific vascular morphology correlations with infarct patterns and clinical outcomes in ischemic stroke patients.

## Key findings

- Borderzone infarct (BZI) and large infarct patterns are associated with worse clinical outcomes compared to artery-to-artery embolism (AAE) and perforating artery infarction (PAI).
- Increased tortuosity and arc length of the contralateral MCA-M1 segment correlate with BZI, while shorter and thinner M1 segments correlate with large infarcts.

## Abstract

To compare the clinical outcomes among various infarct patterns and to investigate the associations between the morphological parameters of contralateral middle cerebral artery (cMCA) M1 segment and infarct patterns in ischemic stroke attributed to large vessel occlusion (LVO) in M1 segment caused by intracranial atherosclerotic disease (ICAD).

Patients with stroke attributed to M1‐ICAD‐LVO were enrolled. The infarct patterns were categorized into artery‐to‐artery embolism (AAE), large infarct, borderzone infarct (BZI), and perforating artery infarction (PAI). The morphological parameters of cMCA‐M1 segment included proximal and distal diameter, arc, and chord length. The tortuosity index of cMCA‐M1 segment was calculated by (arc length/chord length − 1) × 100%.

A total of 171 participants were enrolled. Compared to AAE, the risk of poor outcome increased in BZI (odds ratio [OR] = 5.51, 95% confidence interval [CI] = 1.71–17.78, p = 0.004) and large infarct (OR = 10.92, 95% CI = 2.01–59.27, p = 0.006) and was comparable in PAI. The tortuosity index (OR = 2.85, 95% CI = 1.13–7.18, p = 0.026) and arc length (OR = 2.47, 95% CI = 1.02–5.97, p = 0.045) significantly increased in BZI than other three patterns. Participants other than BZI were categorized into large infarct (n = 32) and non‐large‐infarct (n = 46) groups, and the proximal diameter (OR = 0.22, 95% CI = 0.07–0.72, p = 0.012), arc length (OR = 0.88, 95% CI = 0.78–0.98, p = 0.018), and chord length (OR = 0.87, 95% CI = 0.77–0.995, p = 0.042) were associated with large infarct.

For patients with M1‐ICAD‐LVO, large infarct and BZI had poorer outcomes than PAI and AAE. The cMCA‐M1 segment with elevated tortuosity and arc length was associated with BZI, whereas a thin and short M1 segment was correlated with large infarct in patients with a less tortuous cMCA trunk.

For stroke caused by large vessel occlusion in M1 segment of middle cerebral artery (MCA), a tortuous and long M1 segment of contralateral MCA (cMCA) correlates with the onset of borderzone infarct. In those with a less tortuous cMCA‐M1 segment, a thin and short M1 segment correlates with large infarct.