This study included 16 (53.3%) males and 14 (46.7%) females in lacunar infarction group in addition to 17 (56.7%) males and 13 (43.3%) females in the IBZ infarction group. The age of patients of the whole sample ranged from 48 to 85 years, with a mean age of 63.47 ± 7.637 in lacunar group and 61.30 ± 13.483 in the IBZ group. Most of patients had dyslipidemia (80% in lacunar group and 86.7% in border zone group), hypertension (63.3% in lacunar group and 57.7% in border zone group), while the least common risk factor was ischemic heart disease (13.3% in lacunar group and 26.7% in border zone group. There was no significant difference between groups as regards age, risk factors and number of risk factors (Table 1).

Table 1 Demographic data, risk factors and laboratory findings

Comparing the severity of clinical presentation on admission using NIHSS, it was found that patients with border zone infarction had higher disability than patients with lacunar infarction: median NIHSS (IQ) 12 [6] vs. 7 [6], respectively, (p = 0.001) and on discharge 10 (5.25) vs. 4 [4], respectively, (p < 0.001). Although having different severity of disability (NIHSS) on admission, yet on measuring within-group improvement, both groups improved significantly on discharge (p≤ 0.001 in each group). However, inter-group comparison showed that lacunar group still had more significant improvement than IBZ group (p = 0.001) (Table 2).

Table 2 Comparison of NIHSS and mRS between lacunar infarctions and borderzone infarctions

As for good outcome (mRS ≤ 2) on discharge, 89.9% of lacunar group showed good outcome, vs. 36.7% of IBZ group (p ≤ 0.001). At 3 months follow-up, 96.7% of the lacunar group had a good outcome vs. 53.3% of the IBZ group (p ≤0.001).

It is worth mentioning that within-group comparison showed significant improvement after 3 months (p≤ 0.001) in lacunar stroke compared to (p = 0.02) in IBZ (Table 2).

By investigating VMR in both groups, 56.7% of patients with lacunar stroke had impaired reactivity vs. 100% of patients in IBZ group (p < 0.001). At 3 months follow-up, this number dropped to 23.3% in lacunar group, but persisted as 100% in IBZ group (p < 0.001).

There was statistically significant impairment in all parameters in patients with IBZ infarction than patients with lacunar infarction which means longer TTP, decreased CBF and CBV (p < 0.001, 0.001, 0.023, respectively).

Logistic regression for the lacunar group showed a negative correlation between VMR at baseline and after 3 months with NIHSS (rho = -0.540, p = 0.002, rho = − 0.636, p < 0.001, respectively), which denotes that good VMR correlated with less stroke severity.

There was also a positive statistically significant correlation between inter-side difference CBF and NIHSS (rho = 0.399, p = 0.029), which means that reduced CBF was associated with severer stroke. Three months later mRS did not show significant correlation with any of the studied parameters.

On the other hand, logistic regression analysis for IBZ group could not be performed for VMR since 100% of patients were impaired. Therefore, logistic regression was performed for MRI perfusion parameters vs. degree of stenosis and showed a positive statistically significant correlation between inter-side difference TTP and CBF with degree of stenosis (rho = 0.501, p = 0.005, rho = 0.421, p = 0.021, respectively), denoting that reduced flow is associated with higher stenosis. While no correlation was detected for CBV. There was also no significant correlation between MRI perfusion parameters vs. NIHSS and mRS.

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