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Determinants of ischemia risk in cerebrovascular lesions

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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 vessel lumen decreases, the flow becomes progressively disturbed (from laminar to turbulent), and, on occlusion, it will cease and stagnate. Emboligenicity: Lesions with smooth surfaces and endothelial integrity have little emboligenic potential. As the surface becomes irregular or the endothelium becomes disrupted, subendothelial thrombogenic tissue is exposed to the lumen. In atherosclerotic plaques, neovascularization can lead to intraplaque 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.)