Can Internal Carotid Artery Occlusion Produce Simultaneous Anterior and Posterior Circulation Stroke?

Eswaradass, Prasanna Venkatesan; Ramasamy, Balakrishnan; Kalidoss, Ramadoss; Gnanashanmugham, G

doi:10.4103/0972-0820.166934

Cited by 4 publications

(8 citation statements)

References 4 publications

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“…However, MRA showed a left FPCA and absent right PCA (except for a P1 remnant). As there was no concrete evidence of a right FPCA, we argued-as Eswaradass et al did in their case of concurrent ICA and PCA territory infarction 15 -that an FPCA was present ipsilateral to the infarct but was angiographically invisible because it was occluded. This argument was proved wrong when we discovered evidence of a classic right PCA in the patient's old CT scan files (Figure 1: CT).…”

Section: Discussionmentioning

confidence: 73%

“… 12 - 14 Recently, Eswaradass et al reported the first case of simultaneous PCA, MCA, and ACA territory infarction in association with a possible FPCA; MRA showed complete occlusion of the right ICA and a right FPCA was inferred based on the absence of the P1 segment on MRA. 15 Patient 2 also had ACA, MCA, and PCA territory infarction but, unlike the case of Eswaradass et al, a definite FPCA was found (along with a classic PCA) ipsilateral to the stroke ( Figure 2 : MRA and CTA). In the absence of ICA stenosis and in the presence of atrial fibrillation, the 3-territory stroke in Patient 2 is most likely the result of cardioembolism to the right ACA, MCA, and FPCA (all 3 vessels are branches of the right ICA).…”

Section: Discussionmentioning

confidence: 77%

“…All things considered, the most likely mechanism of paradoxical PCA occlusion in Patient 1 is right ICA-to-PCA embolism through a patent PcomA. Although an FPCA has been implicated in nearly all cases of paradoxical PCA occlusion, 12 - 20 the PcomA is a potential conduit for cross embolization from the ICA to the PCA P2 segment or its distal branches. 12 , 21 The rarity of PcomA embolism may be due to the low ICA-PCA pressure gradient across the PcomA.…”

Section: Discussionmentioning

confidence: 98%

“…Emboli can move up the ICA, enter and occlude the FPCA or its branches, and result in a paradoxical PCA territory infarction-with [12][13][14][15] or without [16][17][18][19][20] attendant occlusion of other ICA branches. A left FPCA was clearly the reason for the left-sided paradoxical infarction in Patient 2.…”

Section: Discussionmentioning

confidence: 99%

“…A few patients with acute ischemic stroke and simultaneous or nearly simultaneous PCA-ICA territory infarction were found to have an FPCA ipsilateral to the paradoxical PCA occlusion. [12][13][14][15] Concurrent infarction occurred in the PCA and MCA territories of one hemisphere, [12][13][14] except in one case where infarction occurred in the PCA, MCA, and ACA territories of the right hemisphere. 15 We report 2 cases of concurrent ICA-PCA territory infarction in the setting of a unilateral FPCA.…”

Section: Introductionmentioning

confidence: 98%

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Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

Lambert

Williams

Oganisyan

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Fetal-type or fetal posterior cerebral artery (FPCA) is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA) territory is perfused by a branch of the internal carotid artery (ICA). In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA) or the anterior (ACA) cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories—right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2. Noninvasive angiography detected a left FPCA in both patients. While FPCA was clearly the mechanism of paradoxical infarction in Patient 2, it turned out to be an incidental finding in Patient 1 when evidence of a classic right PCA was uncovered from an old computed tomography scan image. Differences in anatomical details of the FPCA in each patient suggest that the 2 FPCAs are developmentally different. The FPCA of Patient 1 appeared to be an extension of the embryonic left posterior communicating artery (PcomA). Patient 2 had 2 PCAs on the left (PCA duplication), classic bilateral PCAs, and PcomAs, and absent left anterior choroidal artery (AchoA), suggesting developmental AchoA-to-FPCA transformation on the left. These 2 cases underscore the variable anatomy, clinical significance, and embryological origins of FPCA variants.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

Lambert

Williams

Oganisyan

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Posterior Cerebral Circulation Stroke Secondary to Foetal Origin of Posterior Communicating Artery: An Indication for Carotid Endarterectomy

Mann

Preece

Haslam

et al. 2021

EJVES Vascular Forum

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Effect of Fetal-type Posterior cerebral artery on cerebral infarction and collateral circulation

Fan¹,

Hou²,

Liu³

et al. 2023

Preprint

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We studied 57 patients with cerebral infarction and Fetal-type Posterior cerebral artery (FTP)\, confirmed by MRA and CTA. 26 cases (45.61%) of Complete Fetal-type Posterior cerebral artery (cFTP), 21 cases (36.84%) of Partial Fetal-type Posterior cerebral artery (pFTP), 10 cases (17.54%) of unilateral cFTP.When the ipsilateral internal carotid artery occlusion of cFTP occurs, the bidirectional collateral circulation from the posterior circulation to the posterior communication artery to the anterior circulation cannot be established to compensate, simultaneous infarction of the ipsilateral anterior and posterior circulation can be caused. In the presence of pFTP, since the diameter of P1 was less than that of the posterior communicating artery (PcoA), the collateral circulation of posterior circulation - posterior cerebral artery - middle cerebral artery pia meningeal anastomosis could not be established, anterior circulation infarction was caused by ipsilateral internal carotid artery occlusion. In the presence of bilateral cFTP, the anterior circulation-posterior communication artery-basilar artery could not be established to compensate for the collateral circulation of other branches except bilateral posterior cerebral artery, resulting in bilateral cerebellar and brainstem infarction. FTP changes the cerebral artery circulation and collateral circulation pathways in the normal state.

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Can Internal Carotid Artery Occlusion Produce Simultaneous Anterior and Posterior Circulation Stroke?

Cited by 4 publications

References 4 publications

Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

Posterior Cerebral Circulation Stroke Secondary to Foetal Origin of Posterior Communicating Artery: An Indication for Carotid Endarterectomy

Effect of Fetal-type Posterior cerebral artery on cerebral infarction and collateral circulation

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