Carotid artery findings associated with infarcts in different carotid vascular territories

Brain infarctions in different vascular territories may be caused by different principal mechanisms. To assess the importance of extracranial carotid artery stenosis as a cause of brain infarctions, we compared carotid findings with infarcts in different vascular territories within the carotid circulation in 141 patients. Infarct location was documented with computed tomography, magnetic resonance imaging, or ophthalmoscopy. All patients had a carotid artery study (arteriography in 83 and duplex ultrasound in the remaining 58). Carotid stenosis ipsilateral to infarct was found in 37/69 (54%) patients with superficial infarcts, 7/17 (41%) patients with lenticulostriate territory infarcts, 14/24 (58%) patients with retinal infarcts, but in only 4/31 (13%) patients with anterior choroidal artery territory infarcts (p = 0.001). Among patients with superficial infarcts, hypertension was less common (p = 0.05), and the side with greater carotid stenosis correlated with the side of infarction (p < 0.001). Extracranial carotid stenosis appears to be an important cause of infarctions in the carotid territory, especially in the superficial territories, but not in the anterior choroidal artery territory.