Leys D, Mounier-Vehier F, Lavenu I, Rondepierre P, Pruvo J P
Department of Neurology, University of Lille, France.
Stroke. 1994 Apr;25(4):837-42. doi: 10.1161/01.str.25.4.837.
A previous study suggested that occlusive diseases of small penetrating arteries account for most anterior choroidal artery (AChA) territory infarcts, but half of the patients did not have an echocardiogram. Cases of AChA territory infarcts associated with internal carotid artery stenosis or atrial fibrillation suggest that this hypothesis may be wrong. The aim of this study was to determine the mechanism of 16 nonselected consecutive AChA territory infarcts.
The study population consisted of 8 men and 8 women aged 17 to 89 years. They underwent a computed tomographic scan at the acute stage, Doppler ultrasonography and B-mode echotomography of the cervical arteries, bidimensional transthoracic echocardiography, and cerebral magnetic resonance imaging, replaced by a second computed tomographic scan in 3 patients. Ten patients underwent cerebral angiography. We defined the presumed cause of stroke according to the criteria used in the trial of Org 10172 in acute stroke treatment.
The presumed cause of stroke was definite cardio-embolism in 4 patients (atrial fibrillation in 2, paradoxical embolism in 1, and left ventricular akinesia in 1); definite large-vessel atherosclerosis in 2; dissection of the internal carotid artery in 2; and definite small-vessel occlusion in 1. Seven patients had a negative diagnostic workup. Six patients had no risk factors for small-vessel occlusion. The AChA was not visible on angiography in 4 patients. One patient had two arterial cutoffs, suggestive of emboli in other cerebral arteries.
This study suggests that AChA territory infarcts are rarely related to small-vessel occlusion and therefore require a complete diagnostic workup.
先前的一项研究表明，小穿通动脉闭塞性疾病是大多数脉络膜前动脉（AChA）供血区梗死的原因，但半数患者未进行超声心动图检查。与颈内动脉狭窄或心房颤动相关的AChA供血区梗死病例提示该假说可能有误。本研究旨在确定16例未经选择的连续性AChA供血区梗死的发病机制。
研究对象包括8名男性和8名女性，年龄在17至89岁之间。他们在急性期接受了计算机断层扫描、颈部动脉多普勒超声和B型超声断层扫描、二维经胸超声心动图以及脑磁共振成像检查，3例患者随后进行了第二次计算机断层扫描。10例患者接受了脑血管造影。我们根据急性卒中治疗中Org 10172试验所使用的标准来确定卒中的推测病因。
卒中的推测病因明确为心源性栓塞的有4例（2例为心房颤动，1例为反常栓塞，1例为左心室运动障碍）；明确为大血管动脉粥样硬化的有2例；颈内动脉夹层的有2例；明确为小血管闭塞的有1例。7例患者的诊断检查结果为阴性。6例患者无小血管闭塞的危险因素。4例患者的脑血管造影未显示AChA。1例患者有两处动脉闭塞，提示其他脑动脉存在栓子。
本研究提示，AChA供血区梗死很少与小血管闭塞相关，因此需要进行全面的诊断检查。
