HEMODYNAMIC MECHANISM IN SMALL SUBCORTICAL BORDERZONE INFARCTS

In 143 consecutive, prospectively registered patients with a first-ever stroke due to a small subcortical infarct, we identified 12 patients with a symptomatic small subcortical infarct in the borderzone between the areas supplied by the deep penetrators and the medullary branches of the middle cerebral artery. Four of these had ipsilateral carotid stenosis of more than 50% (1 with total occlusion), as opposed to 3 of 62 remaining patients with CT-confirmed small deep infarcts (odds ratio: 9.83; 95% confidence interval: 1.70-57.04; p < 0.01). The number of patients with a potential cardio-embolic cause did not differ, which makes cardiac embolism a less likely cause of such infarcts. Although in many patients with small deep infarcts local small-vessel obstruction may be the underlying cause, small deep infarcts located in a borderzone may be caused by a haemodynamic mechanism.