Factors associated with the laterality of Cardio-Embolic stroke

Ramy Abdelnaby; Demetris Charalambous; Khaled A Mohamed; Mohamed A Ebrahim; Mosaab Salah El-Din El-Agawy; Martin Wiesmann; Jörg B Schulz; Omid Nikoubashman; Arno Reich; João Pinho

doi:10.1016/j.jstrokecerebrovasdis.2023.107460

Factors associated with the laterality of Cardio-Embolic stroke

J Stroke Cerebrovasc Dis. 2023 Dec;32(12):107460. doi: 10.1016/j.jstrokecerebrovasdis.2023.107460. Epub 2023 Nov 2.

Affiliations

¹ Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany. Electronic address: rabdelnaby@ukaachen.de.
² Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.
³ Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Department of Anatomy & Embryology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Department of Anatomy & Embryology, Faculty of Medicine, New Mansoura University, New Mansoura, Egypt.
⁵ Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Germany.
⁶ Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany.

PMID: 37924780
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107460

Abstract

Objective: Understanding the lateralization factors, including the anatomic and hemodynamic mechanisms, is essential for diagnosing cardio-embolic stroke. This study aims to investigate the elements, for the first time together, that could affect the laterality of stroke.

Methods: We performed a monocentric retrospective case-control study based on prospective registries of acute ischemic stroke patients in the comprehensive stroke center of the RWTH University hospital of Aachen for three years (June 2018-June 2021). We enrolled 222 patients with cardioembolic stroke (136 left stroke and 86 right stroke) admitted for first-ever acute ischemic stroke with unilateral large vessel occlusion of the anterior circulation. The peak systolic velocity (PSV) asymmetry of middle cerebral artery (MCA) was assessed by doppler as well as internal carotid artery (ICA) angle, aortic arch (AA) branching pattern and anatomy were assessed by CT-Angiography.

Results: We found that the increasing left ICA angle (p = 0.047), presence of bovine type AA anatomy (p = 0.041) as well as slow PSV of the right MCA with a value of >15% than left (p = 0.005) were the predictors for left stroke lateralization, while the latter was an independent predictor for the left stroke (OR=3.341 [1.415-7.887]). Inter-Rater Reliability ranged from moderate to perfect agreement.

Conclusion: The predictors for left stroke lateralization include the higher values of left ICA angle, presence of the bovine type AA and the slow right MCA PSV.

Keywords: Embolic; Laterality; Risk factors; Stroke.

MeSH terms

Animals
Carotid Artery Diseases*
Carotid Artery, Internal / diagnostic imaging
Case-Control Studies
Cattle
Embolic Stroke*
Humans
Ischemic Stroke*
Prospective Studies
Reproducibility of Results
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / etiology