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Updated: Apr 11, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Selective Vulnerability of Cortical Border Zone to Microembolic Infarct
Mauro Bergui1, Davide Castagno1, Federico D'Agata2
1From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
Atrial fibrillation ablation can cause silent brain ischemias (SCI) in specific border zones. These microemboli selectively target vulnerable brain areas, particularly the cortical border zones between major cerebral arteries.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Endovascular procedures like atrial fibrillation transcatheter ablation carry a risk of causing microembolization in brain arteries.
- Microemboli frequently lead to small, clinically silent cerebral ischemias (SCI).
- These SCIs are detectable using early postoperative magnetic resonance diffusion-weighted imaging.
Purpose of the Study:
- To analyze the distribution of SCIs in patients undergoing atrial fibrillation transcatheter ablation.
- To identify specific brain regions vulnerable to microemboli during this procedure.
Main Methods:
- Magnetic resonance imaging (MRI) was used to detect acute SCIs in 78 out of 927 patients post-ablation.
- SCI locations were mapped and transformed into standardized neuroanatomical space (ICBM/MNI).
- Activation Likelihood Estimation (ALE) was employed to generate voxel-wise probability distribution maps of SCI.
Main Results:
- SCIs were predominantly observed in cortical regions.
- In supratentorial areas, SCIs specifically affected the border zones between the anterior, middle, and posterior cerebral arteries.
- Infratentorial SCIs were found in the distal territory of the posteroinferior cerebellar artery.
Conclusions:
- A distinct vulnerability of the cortical border zone to microemboli during atrial fibrillation transcatheter ablation was identified.
- This observed selectivity in lesion distribution may be relevant for microemboli originating from various sources.
