Selective Vulnerability of Cortical Border Zone to Microembolic Infarct

  title={Selective Vulnerability of Cortical Border Zone to Microembolic Infarct},
  author={Mauro Bergui and Davide Castagno and Federico D’Agata and Alessandro Cicerale and Matteo Anselmino and Federica Maria Ferrio and Carla Giustetto and Franck Halimi and Marco Scaglione and Fiorenzo Gaita},
Background and Purpose— Endovascular procedures, including atrial fibrillation transcatheter ablation, may cause microembolization of brain arteries. Microemboli often cause small sized and clinically silent cerebral ischemias (SCI). These lesions are clearly visible on early postoperative magnetic resonance diffusion-weighted images. We analyzed SCI distribution in a population of patients submitted to atrial fibrillation transcatheter ablation. Methods— Seventy-eight of 927 consecutive… 

Figures and Tables from this paper

Cerebral border zone infarction: an etiological study

Vascular stenosis is the main etiological factor in internal BZI while AF is the predominant etiology factor of cortical BZI.

Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization

Cerebral embolization plays an important role in the pathophysiology of ischemia in both carotid occlusion and stenosis, even among patients with watershed infarcts.

Brain magnetic resonance imaging and cognitive alterations after ablation in patients with atrial fibrillation

Despite incidental microemboli, cognitive function was preserved 6 months after ablation and detailed neuropsychological assessment scores showed improvement in memory, constructional, and frontal lobe functions.

Cerebral border zone infarctions: An etiologic study

Large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal and external cerebral BZIs and cardioembolism might have a more important etiologic role in the external subtype.

What Makes New Ischemic Lesions Symptomatic after Aortic Valve Replacement?

  • R. LekerS. Messé T. Floyd
  • Medicine
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
  • 2017

Preventing Brain Injury After Cardiopulmonary Bypass Will Require More Than Just Dialing Up the Pressure

A research consortium guideline is recommended to recommend combining neurological examinations, neurocognitive testing, and brain imaging in clinical trials designed to assess neurological outcomes after cardiac procedures to fully characterize the incidence, severity, and clinical sequelae of perioperative brain injury.

Carotid atherosclerosis, silent ischemic brain damage and brain atrophy: A systematic review and meta-analysis.

Outcomes and predictors of periprocedural stroke after transcatheter aortic valve implantation.

Epilepsy in patients undergoing cardiac surgery with ExtraCorporeal Circulation: case series and description of a peculiar clinical phenotype

The peculiar characteristics of epilepsies in terms of seizure semiology, frequency, and drug response are described and the clinical implications of identifying these forms of epilepsy which tend to be often under-recognized are discussed.



Post-Interventional Microembolism: Cortical Border Zone Is a Preferential Site for Ischemia

Interventional-angiography-related microembolisms mostly lodge in the cerebral cortical border zone area and cerebellar hemisphere in patients with silent embolism during neurointerventional procedures.

Mechanisms and clinical features of posterior border-zone infarcts

Embolism, either cardiac or from the parent carotid artery, is the predominant stroke mechanism in unilateral posterior border-zone infarcts, not distal field perfusion failure.

Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: A diffusion‐weighted imaging and microemboli monitoring study

Common stroke mechanisms in patients with middle cerebral artery stenosis are the occlusion of a single penetrating artery to produce a small subcortical lacuna‐like infarct and an artery‐to‐artery embolism with impaired clearance of emboli that produces multiple small cerebral infarCTs, especially along the border zone region.

Silent Cerebral Events/Lesions Related to Atrial Fibrillation Ablation: A Clinical Review

No study has linked SCE/SCL to neuropsychological decline and the low number of AF‐ablation‐associated events needs to be weighted against the multitude of preexisting asymptomatic MRI‐detected brain lesions related to the course of AF itself.

Borderzone infarctions distal to internal carotid artery occlussion: Prognostic implications

As WS infarctions were the most frequent type of infarction distal to an occluded ICA, appropriate treatment of all potential causes of systemic hemodynamic disturbances may be crucial in the long‐term management of patients with ICA occlusion.

Impaired Washout – Embolism and Ischemic Stroke: Further Examples and Proof of Concept

Patients with severe hemodynamic compromise of either arterial or venous origin, or both, and natural or iatrogenic mechanisms of embolism are identified and subcortical arterial embolization within an atypical borderzone of hypoperfusion was observed.

Very small (border zone) cerebellar infarcts. Distribution, causes, mechanisms and clinical features.

It is concluded that very small cerebellar infarcts are often found on CT and MRI and most often result from large or pial artery disease rather than from systemic hypotension.

Internal and Cortical Border-Zone Infarction: Clinical and Diffusion-Weighted Imaging Features

IBZ infarcts are caused mainly by hemodynamic compromise, whereas embolic pathogenesis appears to contribute greatly to the genesis of CBZ infaratects, suggesting that different therapeutic approaches may be required to prevent early clinical deterioration in patients with different types of border-zone infarction.

Directed embolization is an alternate cause of cerebral watershed infarction.

The findings in these cases support the hypothesis that small thromboemboli may not be randomly distributed in the cerebral arterial supply but may be preferentially distributed to the small terminal arterial branches in the borderzones between major arterial territories.

Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures.

The cortical hemispheric location of ischemic strokes is associated with a higher risk of early-onset seizures and the watershed mechanism is a strong and independent determinant of stroke-related ES among patients with cortical involvement.