Neurological Disorders

Infarct Patterns in the Middle Cerebral Artery Territory and Their Association with Large Artery Stenosis

Abstract

Martin Osorio Flores, Y Swamy Venkatesh, Ambika Rao and Michael Brooks

Background and Purpose: We investigated the association between critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery and patterns of cerebral infarcts classified by their territorial distribution.

Methods: This cross-sectional study included patients with diffusion-weighted magnetic resonance-confirmed acute/early subacute infarcts in the middle cerebral artery territory who underwent head/neck magnetic resonance angiography. We grouped infarct patterns in two categories: shower/cortical watershed/superficial perforating territory and complete middle cerebral artery/cortical territorial/deep perforating territory.

Results: Seventeen and 33 patients, respectively, presented with shower/cortical watershed/superficial perforating territory infarcts and complete middle cerebral artery/cortical territorial/deep perforating territory infarcts. Eleven (64.7%) of the former and five (15.2%) of the latter had critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery. A strong statistical association favoring the presence of critical stenosis in the shower/cortical watershed/superficial perforating territory group (P=.001) persisted on logistic regression analysis (P=.002).

Conclusions: The occurrence of diffusion-weighted magnetic resonance-confirmed acute/early subacute middle cerebral artery infarcts in the shower/cortical watershed/superficial perforating territory distribution is strongly associated with the presence of critical stenosis of the internal carotid artery or the first segment of the middle cerebral artery. Further prospective studies are needed to address the significance of this finding.