Internal borderzone infarction following acute middle cerebral artery occlusion
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U Angeloni1, L Bozzao, L Fantozzi
1Department of Neurological Sciences, Univesity of Rome, La Sapienza, Rome, Italy.
Insights
Internal borderzone infarctions can result from middle cerebral artery (MCA) branch occlusions alone. These strokes do not always require hemodynamic changes from extracranial large vessel disease.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Middle cerebral artery (MCA) occlusions are a common cause of ischemic stroke.
- Internal borderzone infarcts are typically associated with hemodynamic compromise from extracranial disease.
- The specific causes of internal borderzone infarcts in MCA occlusion require further elucidation.
Purpose of the Study:
- To investigate the angiographic and CT findings in patients with acute MCA occlusion.
- To determine the relationship between the location of MCA occlusion and infarct patterns.
- To assess the role of intracranial versus extracranial factors in the development of internal borderzone infarctions.
Main Methods:
- Retrospective study of 36 patients with acute MCA occlusion.
- Angiographic assessment within 6 hours of stroke onset.
- Follow-up CT scans at 3 months to evaluate infarct patterns.
- Correlation of infarct patterns with MCA occlusion site and carotid artery status.
Main Results:
- Distal pial MCA branch occlusions were associated with internal borderzone infarction in 7 patients, without extracranial stenosis/occlusion.
- Proximal MCA branch occlusions (before lenticulostriate arteries) led to extensive MCA territory infarction in 14 patients, often with concomitant carotid disease.
- Fifteen patients had mixed occlusions with patchy damage; no superficial cortical watershed infarcts were observed.
Conclusions:
- Intracranial MCA branch occlusions, particularly distal ones, can independently cause internal borderzone infarcts.
- Hemodynamic alterations from large vessel extracranial disease are not always necessary for internal borderzone infarct formation.
- Understanding infarct patterns aids in differentiating causes of stroke and guiding treatment strategies.
Abstract:
In 36 patients suffering acute middle cerebral artery (MCA) occlusion, we studied the angiographic findings within 6 hours of the ictus and the chronic CT results at 3 months. Seven patients suffering distal pial MCA branch occlusion developed a pattern of internal borderzone infarction on follow-up CT. Carotid artery or carotid siphon stenosis or occlusion was absent in all seven. Proximal MCA branch occlusions, prior to the origin of the lenticulostriate arteries, were associated with extensive cortical and deep infarction in the entire MCA territory in 14 patients. There was proximal carotid artery or siphon stenosis or occlusion in 12 of these 14 patients. The remaining 15 patients showed a mixture of proximal and distal MCA occlusions and patchy ischemic damage in the MCA territory. There were no cases of superficial cortical watershed infarction. These data show that internal borderzone infarctions may result from intracranial MCA branch occlusions alone and need not be associated with hemodynamic alterations due to large vessel extracranial disease.