Large artery atherosclerotic versus cardioembolism subtypes of large hemispheric infarction in the middle cerebral artery.

Background: Large hemispheric infarction (LHI) of the middle cerebral artery (MCA) is linked to high mortality and morbidity. This study aims to investigate the characteristics of large artery atherosclerosis (LAA) and cardioembolism subtypes of LHI in MCA.

Methods: This retrospective cohort study included 70 patients with LHI hospitalized at the Second Affiliated Hospital of Anhui Medical University from May 2019 to May 2021. Patients were classified according to the TOAST classification into LAA and cardioembolism subtypes.

Results: Among the 70 patients, 44 were identified with the LAA subtype (aged 76.00 years, 50% were male) and 26 with cardioembolism (aged 71.50 years, 57.1% were male). The LAA group exhibited significantly higher rates of hyperhomocysteinemia (18.2% vs. 0%, P = 0.022) and diabetes (38.6% vs. 15.4%, P = 0.042). In contrast, atrial fibrillation prevalence was higher in the cardioembolism group (84.6% vs. 20.5%, P < 0.001), as was the rate of decompressive craniectomy (15.4% vs. 2.3%, P = 0.041), while, hypertension prevalence, thrombectomy, and rehabilitation scores, showed no significant differences (all P > 0.05). Additionally, multivariable linear regression analysis showed that, after adjusted the confounders, LAA (vs. CE) subtype was independently associated with higher mRS scores (β = 0.86, 95%CI: 0.61-1.22), higher NIHSS (β = 4.85, 95%CI: 0.19-9.89), higher Visual Analog Scale (VAS) (β = 0.86, 95%CI: 0.66-1.12), and higher GCS (β = 0.62, 95%CI: 0.09-4.00) (all P < 0.05).

Conclusions: Patients with the LAA subtype of LHI in MCA are more likely to have hyperhomocysteinemia and diabetes, while atrial fibrillation and the need for decompressive craniectomy are more prevalent in the cardioembolism subtype. LHI subtypes may significantly impact patient rehabilitation outcomes.