Perfusion Deficits in Different Mechanisms of Two Subtypes of Acute Stroke with Diffusion MRI confirmation

Background: Branch atheromatous disease (BAD) and lacunar infracts (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke. Methods: : Five-hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. The subtype of ischemic stroke was diagnosed according to DWI imaging. Baseline characteristics between normal and abnormal CTP results in BAD and LI were compared with chi-square or Fisher’s exact test for categorical. The t-test or Mann-Whitney U test was performed for continuous variables. Results: : One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) the BAD group and 5 of 18 (27.8%) the LI group had perfusion deficits in the supratentorial region. The BAD group had a higher proportion of abnormal perfusion than the LI group, with a significant difference ( P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in the BAD patients. Conclusions: : Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.