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Determinants of ischemia risk in cerebrovascular lesions

The major attributes that determine the degree of ischemic risk inherent to any cerebrovascular lesion are depicted in this artistic rendition. Hemodynamic Impact: As the lumen of the vessel decreases, the flow becomes progressively disturbed (from laminar to turbulent), reduced and, on occlusion, will cease and stagnate. Emboligenicity: Lesions with smooth surface and endothelial integrity have little emboligenic potential. As the surface becomes irregular and/or the endothelium becomes disrupted, sub-endothelial thrombogenic tissue is exposed to the lumen. In atherosclerotic plaques, neovascularization can lead to intra-plaque hemorrhage, which is capable of acute rupture and sudden lumen reduction. Branch Involvement: Pathology of the parent vessel may either extend into different branches, or embed smaller collaterals, creating more than one compartment of ischemia. (Contributed by Dr. Camilo Gomez.)

Associated Disorders

  • Carotid atherosclerosis
  • Cerebrovascular disease
  • Coronary artery disease
  • Diabetes
  • Extracranial carotid artery occlusive disease
  • Intracranial atherothrombosis
  • Intracranial occlusive disease
  • Myocardial infarction
  • Peripheral vascular disease