From a prospective registry of all consecutive patients with a supratentorial
ischaemic stroke, those with a compatible CT lesion were selected to study topographical relationship, clinical syndrome, vascular risk 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 identified the area supplied by the
AChA: in accordance with the consensus in the literature the posterior two-thirds of the posterior leg of the internal capsule was considered as certain
AChA territory. After reviewing CT scans, all presumed small deep
AChA territory
infarcts were displayed in a schematic composite picture of super-imposed areas of
infarction in different shades of grey.
Infarcts that were located largely outside the generally included territory were presumed to belong to a different vascular territory. Thus, 77 small deep
infarcts were considered to be located within, and 83 outside the
AChA territory. Twenty-nine
AChA infarcts extended from the internal capsule upwards into the posterior paraventricular corona radiata region. Furthermore, the composite representation of 26
infarcts restricted to the posterior part of the paraventricular corona radiata region showed almost complete overlap with the area occupied by
AChA infarcts that extended upwards. 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 remaining small deep
infarcts. Comparison of vascular risk factors by way of multivariate regression analysis only showed that a significant
carotid stenosis was more frequent (adjusted odds ratio 8.87; 95% confidence interval 1.44-54.50), and a cardioembolic source was less frequent (odds ratio 0.24; 95% confidence interval 0.07-0.92) in
AChA infarcts than in the other small deep
infarcts.
Carotid stenosis and cardiac
embolism were less frequent in
AChA infarcts than in superficial
infarcts (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 to younger age in the
AChA patients. Larger
AChA infarcts were infrequent in our series; six of such cases did not 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
AChA infarcts do not constitute a separate
brain infarct entity.(ABSTRACT TRUNCATED AT 400 WORDS)