Tertiary microvascular territories define lacunar infarcts in the basal ganglia

Abstract

Lacunar infarcts are commonly found in the basal ganglia, though little is known about the organization of small-scale microvascular territories that presumably subtend lacunae. We investigated microvascular territories of the lenticulostriate arteries, the recurrent artery of Heubner, the anterior choroidal artery, and striate branches of the anterior cerebral and anterior communicating arteries in perfusion-fixed human brains by simultaneous injection of fluorescent dyes and a radio-opaque substance in 5% gelatin. Territories were defined by ultraviolet illumination of dye and high-resolution mammography of radio-opaque substance. Brains were sectioned coplanar with the Talairach proportional grid system and vascular data were plotted, allowing for application to any human brain. The data suggest first that the lenticulostriate artery, recurrent artery of Heubner, and anterior choroidal artery supply distinct territories of the basal ganglia with minimal overlap and sparse anastomoses between major penetrating vessels. Individual territories are spatially consistent across brains and match the extent of major/minor infarcts. Second, branching patterns of parental, second-, and third-order vessels leading to circumscribed terminal vascular beds could account structurally for "lacunar" infarcts.

MR Imaging of Subcallosal Artery Infarct Causing Amnesia after Surgery for Anterior Communicating Artery Aneurysm

“…Basal forebrain anatomy was identified on MPRs such as in On-line Fig 2, by referencing multiple coronal brain specimens with detailed diagrams (with 0.7-to 1.5-mm intersectional gap) by Mai et al 22 Regarding the vascular territories of infarction, we referenced descriptions of arterial supply of the basal forebrain in the radio-anatomic literature 16,23,24 and specifically focused on the following 16 regions of the basal forebrain per hemisphere: 8 regions of the territory of the subcallosal artery (anterior cingulate gyrus; anterior commissure; column of the fornix; paraterminal gyrus, including a part of the septum pellucidum; preoptic area; rostrum and genu of the corpus callosum; and subcallosal area). 13,16 Because the recurrent artery of Heubner (RAH), which usually originates on both sides around the junction of the ACoA and the anterior cerebral artery (Fig 1), 25,26 is also considered at high risk of injury from treatment of ACoA aneurysms, 5 regions of the territory of the RAH were also included in this analysis (anterior limb of the internal capsule, caudate nucleus, globus pallidus, nucleus accumbens, and putamen).…”

Visualization of Lenticulostriate Arteries by Flow-Sensitive Black-Blood MR Angiography on a 1.5T MRI System: A Comparative Study between Subjects with and without Stroke

“…[3][4][5] LSA branches can be clearly observed by using digital subtraction angiography, though this technique is invasive. 6,7 Recently, LSA branches have been successfully visualized with 7T MR imaging by using timeof-flight MRA, 8,9 and relationships between decreased LSA visualization and hypertension or infarction at the basal ganglia and/or its vicinity were demonstrated.…”

Arterial branching and basal ganglia lacunes: A study in pure small vessel disease

“…We cannot be sure that CADASIL patients have the same vascular anatomy as subjects used to derive the microangiographic templates; however, the principal anatomy is thought to be uniform across individuals. 10 Our findings may have clinical relevance. Identifying small lacunes from third-and second-order vessels on scans from stroke patients would suggest cerebral SVD as the likely aetiology.…”