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Cortex-sparing infarctions in patients with occlusion of the middle cerebral artery
  1. Han Jin Cho1,2,
  2. Jae Hoon Yang1,
  3. Yo Han Jung1,
  4. Young Dae Kim1,
  5. Hye-Yeon Choi1,
  6. Hyo Suk Nam1,
  7. Ji Hoe Heo1
  1. 1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
  2. 2Department of Neurology, Pusan National University College of Medicine and Medical Research Institute, Busan, Korea
  1. Correspondence to Professor Ji Hoe Heo, Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemoon-ku, Seoul 120-752, Korea; jhheo{at}


Background In patients with a middle cerebral artery (MCA) occlusion, the involvement of the cortex may be affected by the presence of leptomeningeal anastomoses between the cerebral arteries.

Methods The authors enrolled consecutive patients with acute infarctions in the MCA territory and MCA occlusion on angiographic studies. Infarct patterns were classified into three categories based on the extent of cortical surface involvement: total cortex (TC), partial cortex (PC) and no cortex (NC). The authors analysed the infarction patterns by stroke subtype, and investigated factors that resulted in cortex sparing.

Results Out of 73 total patients, cortex-sparing infarctions were seen in 53 patients (72.6%, NC in 39 (53.5%) and PC in 14 (19.1%)). The extent of cortical involvement differed according to stroke subtype (p=0.036). TC was more frequent (42.9% vs 22.2%), and PC was less frequent (10.7% vs 27.9%, p=0.037) in cardioembolism than large-artery atherosclerosis. However, the proportion of patients with complete cortical sparing (NC) was similar between cardioembolism and large-artery atherosclerosis (46.4% vs 49.9%). In the upstream of leptomeningeal collateral arteries, the extent of cortical involvement was associated with significant stenosis of the ipsilateral anterior or posterior cerebral artery (p=0.011).

Conclusion This study suggests that pre-existing arteriolar connections, which may cover almost entire cortical surfaces of the MCA territory, exist in many patients. The findings also suggest that the extent of cortical involvement is different between stroke subtypes, and is critically affected by the status of upstream collateral arteries.

  • Cerebrovascular disease
  • middle cerebral artery
  • collateral circulation

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  • Funding This work was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A080602).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Review Board of Severance Hospital, Yonsei University Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.