INFARCTS IN THE ANTERIOR CHOROIDAL ARTERY TERRITORY - ANATOMICAL DISTRIBUTION, CLINICAL SYNDROMES, PRESUMED PATHOGENESIS AND EARLY OUTCOME

From a prospective registry of all consecutive patients with a suprate ntorial ischaemic stroke, those with a compatible CT lesion were selec ted to study topographical relationship, clinical syndrome, vascular r isk factors, signs of large-vessel disease or cardiogenic embolism and mortality in cases with an infarct in the anterior choroidal artery ( AChA) territory in comparison with other infarct subtypes. First we id entified the area supplied by the AChA: in accordance with the consens us in the literature the posterior two-thirds of the posterior leg of the internal capsule was considered as certain AChA territory. After r eviewing CT scans, all presumed small deep AChA territory infarcts wer e displayed in a schematic composite picture of super-imposed areas of infaraction in different shades of grey. Infarcts that were located l argely outside the generally included territory were presumed to belon g to a different vascular territory. Thus, 77 small deep infarcts were considered to be located within, and 83 outside the AChA territory. T wenty-nine AChA infarcts extended from the internal capsule upwards in to the posterior paraventricular corona radiata region. Furthermore, t he composite representation of 26 infarcts restricted to the posterior part of the paraventricular corona radiata region showed almost compl ete overlap with the area occupied by AChA infarcts that extended upwa rds. We therefore concluded that the posterior paraventricular area is most likely supplied by the AChA. The frequency of a clinical lacunar or a cortical syndrome did not differ between small deep AChA and rem aining small deep infarcts. Comparison of vascular risk factors by, wa y of multivariate regression analysis only showed that a significant c arotid stenosis was more frequent (adjusted odds ratio 8.87; 95% confi dence interval 1.44-54.50), and a cardioembolic source was less freque nt (odds ratio 0.24; 95% confidence interval 0.07-0.92) in AChA infarc ts than in the other small deep infarcts. Carotid stenosis and cardiac embolism were less frequent in ACM infarcts than in superficial infar cts (odds ratio 0.33, 0.23, respectively; 95% confidence interval 0.15 -0.74, 0.09-0.52, respectively). One month and one year mortality were lower in small deep infarcts compared with superficial infarcts, but most favourable in the AChA group. However this was probably related t o younger age in the AChA patients. Larger AChA infarcts were infreque nt in our series; six of such cases did nor differ in any respect from superficial infarcts. We conclude that the posterior paraventricular corona radiata region is most likely supplied by the AChA, and that AC hA infarcts do not constitute a separate brain infarct entity. Consequ ently such infarct cases should be treated as similar brain infarct su btypes.