Acute Anterior Choroidal Artery Territory Infarction: A Retrospective Study

To explore the clinical features, risk factors, etiopathogenesis, mechanism of progression, effect of intravenous thrombolysis therapy (IVT) and prognosis of acute ischemic stroke (AIS) in the anterior choroidal artery (AChA) territory.

A total of 113 AChA infarction patients were enrolled in the current study retrospectively. The demographic and clinical characteristics were collected and analyzed in all patients. The clinical characteristics were compared between clinical progression and no clinical progression groups, good and poor outcome groups, as well as with and without intravenous rt-PA groups.

Hemiparesis was the most common clinical manifestation (92.9%), followed by dyslexia (54.9%), hemianesthesia (43.4%) and other syndromes. Forty-nine patients (43.4%) suffered from clinical progression and showed a higher rate with multiple risk factors together than patients without clinical progression (30.6% vs.14.1%, P = 0.039). Moreover, more patients with progression were found with carotid plaques (73.5% vs. 51.6%, P = 0.018) or carotid artery stenosis (18.4% vs. 6.3%, P = 0.045) than patients without progression. 69.9% of patients got good prognosis at 6-months. In good prognosis group, the proportion of patients with atrial fibrillation, clinical progression and large infarct size were significantly lower than in poor prognosis group (1.3% vs. 11.8%, P = 0.047; 23.9% vs. 67.6%, P = 0.001; 15.2% vs. 38.2%, P = 0.007). No significant difference was found on rate of clinical progression and good prognosis between patients with and without IVT.

Motor deficits are the most frequent and typical symptoms in AChA infarcts. Although small artery disease was considered to be the important etiopathogenesis of the AChA infarcts, large vascular disease may be associated with clinical progression in AChA infarcts. Additionally, prognosis of AChA infarcts is correlated with clinical progression, infarct size and atrial fibrillation. IVT does not seem to prevent the clinical progression and improve prognosis of AChA infarcts.