Vascular territories of the brain

The anatomical term “arterial vascular territories of the brain” refers to the different zones of the brain based on its arterial blood supply. But the concept of “vascular territory” is not clear because it may refer to anatomic considerations (different intracranial vascular territories are usually visualized with the use of angiographic techniques, or on cadaver), localization of infarcts in imaging (not necessarily reliable to a dedicated artery: ie watershed infarcts…), or stroke patterns.

Moreover, based on an autopsy series, it has been demonstrated that the variability of the cerebral vascular territories is significantly greater than is generally assumed. One of the most vital and clinically relevant implications of these reports is that the interpretation of individual infarction patterns may be confounded by such vascular variability.

But knowledge of the arterial vascular territories is important, because it enables us to recognize infarctions in arterial territories.

Here is presented the habitual classification of cerebral vascular territories of the brain, divide on the basis of internal and vertebral artery blood supply respectively:

• Anterior circulation (internal carotid artery):

  • Territory of anterior cerebral artery (cortical branches)

  • Territory of medial lenticulo-striate arteries and Heubner artery (Deep ACA A1-segment)

  • Territory of middle cerebral artery (cortical branches of MCA)

  • Territory of lateral lenticulo-striate arteries (M1-segment of MCA) 

  • Territory of anterior choroidal artery (AchA)

• Posterior circulation (vertebral artery)

  • Territory of posterior communicating artery

  • Territory of posterior cerebral artery

  • Territory of branches from basilar artery

    • Territory of superior cerebellar artery (SCA)

    • Territory of anterior inferior cerebellar artery (AICA)

    • Territory of posterior inferior cerebellar artery (PICA)

  • Territory of branches from vertebral artery and anterior spinal artery

• Watershed zones (ischemic lesions that occur in characteristic locations at the junction between two main arterial territories)

  • Cortical vascular watershed zone

  • Cortical vascular watershed zone - Anterior

  • Cortical vascular watershed zone - Posterior

  • Deep white matter vascular watershed zone