Cerebral hemodynamics and stroke risks in symptomatic intracranial atherosclerotic stenosis with internal versus cortical borderzone infarcts: A computational fluid dynamics study

Shuang Li, Xuan Tian, Bonaventure Ip, Xueyan Feng, Hing Lung Ip, Jill Abrigo, Linfang Lan, Haipeng Liu, Lina Zheng, Yuying Liu, Yu Liu, Karen KY Ma, Florence SY Fan, Sze Ho Ma, Hui Fang, Yuming Xu, Alexander Y Lau, Howan Leung, Yannie OY Soo, Vincent CT MokKa Sing Wong, Xinyi Leng, Thomas W Leung

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There may be different mechanisms underlying internal (IBZ) and cortical (CBZ) borderzone infarcts in intracranial atherosclerotic stenosis. In 84 patients with symptomatic, 50-99% atherosclerotic stenosis of M1 middle cerebral artery (MCA-M1) with acute borderzone infarcts in diffusion-weighted imaging, we classified the infarct patterns as isolated IBZ (n = 37), isolated CBZ (n = 31), and IBZ+CBZ (n = 16) infarcts. CT angiography-based computational fluid dynamics models were constructed to quantify translesional, post-stenotic to pre-stenotic pressure ratio (PR) in the MCA-M1 lesion. Those with IBZ infarcts were more likely to have a low PR (indicating impaired antegrade flow across the lesion) than those without (p = 0.012), and those with CBZ infarcts were more likely to have coexisting small cortical infarcts (indicating possible embolism) than those without (p = 0.004). In those with isolated IBZ or CBZ infarcts, low PR was independently associated with isolated IBZ infarcts (adjusted odds ratio = 4.223; p = 0.026). These two groups may also have different trajectories in the stroke risks under current medical treatment regimen, with a higher risk of same-territory ischemic stroke recurrence within 3 months in patients with isolated IBZ infarcts than isolated CBZ infarcts (17.9% versus 0.0%; log-rank p = 0.023), but similar risks later in 1 year.
Original languageEnglish
Pages (from-to)(In-Press)
JournalJournal of Cerebral Blood Flow and Metabolism
Early online date28 Oct 2023
Publication statusE-pub ahead of print - 28 Oct 2023

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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Early Career Scheme (Reference number 24103122), Research Grants Council of Hong Kong; Li Ka Shing Institute of Health Sciences.


  • Borderzone infarct
  • cerebral hemodynamics
  • intracranial atherosclerotic disease
  • ischemic stroke
  • prognosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine


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