Acute ischemic stroke in anterior choroidal artery territory

ObjectiveThe aim of the study was to describe a series of patients with acute ischemic infarct in the anterior choroidal artery (AChA) territory. Moreover, we analyzed the prevalence of these strokes and compared them with hemispheric and deep infarcts. Finally, we hypothesized that the size of the infarct could be related to aetiology and prognosis.MethodsWe studied a prospective series of 1350 patients with acute ischemic stroke. We analyzed the following factors: age, gender, diabetes mellitus, hypertension, hyperlipidaemia, current smoking, ischemic heart disease, previous stroke, peripheral arterial disease, prior antithrombotic treatment, major cardioembolic source, severe arterial stenosis, initial severity, progression, mortality, disability, and recurrence rate at three months. AChA strokes were classified as small (< 20 mm) or large (≥ 20 mm), as measured by diffusion-weighted MRI, and compared by size in the analysis.Results112 patients (8.3%) had an ischemic lesion restricted to the AChA territory (large: 42 patients, small: 70 patients). Patients with AChA infarcts were younger, more likely to be diabetic, and predominantly male. We found significant differences in the rate of major embolic sources, recurrence, progression and prognosis. Large AChA strokes were associated with embolic pathologies and had worse prognosis than small AChA strokes.InterpretationInfarcts in the AChA territory have different aetiological mechanisms and outcome than other territories. Large AChA infarcts have a higher association with an embolic source and worse prognosis than small lesions.