title: Selective Vulnerability of Cortical Border Zone to Microembolic Infarct.
abstract: OBJECTIVE
  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 patients submitted to atrial fibrillation transcatheter ablation were found positive for acute SCI on a postoperative magnetic resonance. SCI were identified and marked, and their coordinates were transformed from native space into the International Consortium for Brain Mapping/Montreal Neurological Institute space. We then computed the voxel-wise probability distribution map of the SCI using the activation likelihood estimation approach.
  
  
  RESULTS
  SCI were more commonly found in the cortex. In supratentorial regions, SCI selectively involved cortical border zone between anterior, middle, and posterior cerebral arteries; in infratentorial regions, distal territory of posteroinferior cerebellar artery. Possible explanations include selective embolization, linked to the vascular anatomy of pial arteries supplying those territories, reduced clearance of emboli in a relatively hypoperfused zone, or a combination of both. This particular distribution of lesions has been reported in both animal models and in patients with microemboli of different sources.
  
  
  CONCLUSIONS
  A selective vulnerability of cortical border zone to microemboli occurring during atrial fibrillation transcatheter ablation was observed. We hypothesize that such selectivity may apply to microemboli of different sources.
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Mauro
authors.initials: M
authors.lastname: Bergui
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.). federico.dagata@unito.it.
authors.forename: Federico
authors.initials: F
authors.lastname: D'Agata
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicerale
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Federica
authors.initials: F
authors.lastname: Maria Ferrio
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Carla
authors.initials: C
authors.lastname: Giustetto
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Franck
authors.initials: F
authors.lastname: Halimi
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: From the Section of Neuroradiology, Department of Neuroscience (M.B., F.D., A.C., F.M.F.), Division of Cardiology, Department of Medical Science (D.C., M.A., C.G., F.G.), University of Turin, Torino, Italy; Centre Medico-Chirurgical Parly 2, Le Chesnay, France (F.H.); and Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy (M.S.).
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged
keywords: atrial fibrillation; brain ischemia, etiology; cardiac surgical procedures, adverse effects; magnetic resonance imaging