Association of inferior division MCA stroke location with populations with atrial fibrillation incidence

Ganghyun Kim; Emilia Vitti; Melissa D Stockbridge; Jeffrey L Saver; Argye E Hillis; Andreia V Faria

doi:10.1016/j.heliyon.2023.e15287

Association of inferior division MCA stroke location with populations with atrial fibrillation incidence

Heliyon. 2023 Apr 5;9(4):e15287. doi: 10.1016/j.heliyon.2023.e15287. eCollection 2023 Apr.

Authors

Ganghyun Kim¹, Emilia Vitti², Melissa D Stockbridge², Jeffrey L Saver³, Argye E Hillis^{2

4}, Andreia V Faria⁵

Affiliations

¹ Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA.
² Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
³ Department of Neurology, School of Medicine, University of California, Los Angeles, CA, USA.
⁴ Department of Physical Medicine & Rehabilitation, and Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA.
⁵ Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Background and aim: Considering the anatomical features of Middle Cerebral Artery (MCA) bifurcation, larger emboli are more likely to enter the inferior division over the superior division. Since emboli of cardiac origin are larger on average than emboli of arterial origin, we hypothesize that the infarcts in temporal and parietal lobes are more likely associated to atrial fibrillation than those in the frontal lobes, therefore occurring more often in populations with higher incidence of atrial fibrillation, such as male (compared to women) and white (compared to black) patients.

Methods: We included 197 patients with MCA "temporoparietal predominant" infarcts and 105 with "frontal predominant" infarcts. Variations between stroke location (frontal or temporoparietal), sex, and race were examined via Chi-square test.

Results: Male patients were more likely than female patients to be afflicted by temporoparietal strokes versus frontal strokes, while white patients had greater likelihood than black patients to be afflicted by temporoparietal strokes versus frontal strokes. Patients with confirmed diagnosis of atrial fibrillation display more temporoparietal strokes compared to frontal strokes.

Conclusion: Temporoparietal MCA ischemic strokes occur more frequently in male and white patients: populations with known increased incidence of atrial fibrillation. In addition, population-specific anatomical characteristics of the MCA bifurcation might favor the larger cardiac emboli to enter the inferior division and cause temporoparietal infarcts. This association can help guide search for the most likely etiology of infarcts.

Keywords: Arterial territories; Atrial fibrillation; Infarction volume; Magnetic resonance imaging; Stroke.

Grants and funding

P41 EB031771/EB/NIBIB NIH HHS/United States