Abstract
Background and Purpose: We investigated the association between critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery and patterns of cerebral infarcts classified by their territorial distribution. Methods: This cross-sectional study included patients with diffusion-weighted magnetic resonance-confirmed acute/early subacute infarcts in the middle cerebral artery territory who underwent head/neck magnetic resonance angiography. We grouped infarct patterns in two categories: shower/cortical watershed/superficial perforating territory and complete middle cerebral artery/cortical territorial/deep perforating territory. Results: Seventeen and 33 patients, respectively, presented with shower/cortical watershed/superficial perforating territory infarcts and complete middle cerebral artery/cortical territorial/deep perforating territory infarcts. Eleven (64.7%) of the former and five (15.2%) of the latter had critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery. A strong statistical association favoring the presence of critical stenosis in the shower/cortical watershed/superficial perforating territory group (P=.001) persisted on logistic regression analysis (P=.002). Conclusions: The occurrence of diffusion-weighted magnetic resonance-confirmed acute/early subacute middle cerebral artery infarcts in the shower/cortical watershed/superficial perforating territory distribution is strongly associated with the presence of critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery. Further prospective studies are needed to address the significance of this finding.
Highlights
The relationship between different distribution patterns of cerebral infarcts and the presence of internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis has been studied with inconsistent results [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]
We sought to determine the presence of an association between critical stenosis of either the ICA or the first segment (M1) of the MCA and different patterns of cerebral infarcts classified according to their territorial distribution
The occurrence of acute/ early subacute middle cerebral artery infarcts in the shower/cortical watershed/superficial perforating territory distribution is strongly associated with the presence of critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery
Summary
The relationship between different distribution patterns of cerebral infarcts and the presence of internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis has been studied with inconsistent results [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. Most studies distinguish between infarcts in the area of the perforating arteries (the terminal arteries leaving the larger cortical vessels and penetrating the white matter into deeper levels) and “internal borderzone” infarcts, considered to be located at the border of two facing, perforating vascular systems. This distinction is not consistently defined in the literature, with infarcts in the same territory, in the deepest areas of the brain, classified within the perforating territory ( the superficial perforating territory) in some studies and within the internal borderzone territory in others. We investigated the association between critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery and patterns of cerebral infarcts classified by their territorial distribution
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