Internal carotid artery stenosis presenting as ipsilateral posterior cerebral artery ischaemic stroke: a lesson to be learnt

Hunter, Jonathan; Tehrani, Sanaz Kahlili; Wood, Tanya; Geraghty, Richard

doi:10.1136/bcr-2013-008848

Cited by 7 publications

(13 citation statements)

References 12 publications

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“…It is generally accepted that less severe stenosis (<70% diameter narrowing) is not associated with a decrease in the volume flow rate through the ipsilateral artery, and the presence of severe stenosis at the carotid can diminish the flow-related enhancement in the downstream arterial bed [ 4 ], which was confirmed in our research by the decrease of flux in the ACA from the ICA. Variation of the CoW is considered to be a major risk factor for strokes [ 7 ].…”

Section: Discussionsupporting

confidence: 83%

“…As an important pathway for cerebral blood supply, the internal carotid artery is a popular site for stenosis worldwide [ 3 ]. Stenosis of the ICA is closely associated with stroke, transient ischemia attack [ 4 ], and cognition impairment [ 5 ]. The synergistic effect of cerebral artery stenosis and other arteries, such as the intracranial arteries and carotid artery system, might increase the risk of ischemic stroke [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis

Lin

Ma²,

Deng³

et al. 2015

Med Sci Monit

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BackgroundThe circle of Willis (CoW) plays an important role in cerebral collateral circulation. The hemodynamics changes in the CoW have usually been associated with the internal carotid artery (ICA) stenosis, but whether rotatory manipulation will affect it remains unknown.Material/MethodsIn this study we attempted to analyze the influence of rotatory manipulation on the hemodynamics in the CoW in models with or without ICA stenosis by means of finite element analysis. For this purpose, the CoW was reasonably simplified and a fluid-solid coupling 3D finite element model was created by using MIMICS10.0 and ANSYS14.5. The healthy (without stenosis) and the diseased (ratios of stenosis include 15%, 30%, 45%, 60%, 70%, 80%, and 90%) situations were simulated. A remote displacement of 60° was applied at a distal ICA (the right ICA was chosen here) to imitate the rotatory manipulation. Blood flow was then monitored at the anterior communicating artery (ACoA) and posterior communicating arteries (PCoA).ResultsBefore the conduction of rotatory manipulation, blood flow changed significantly only when the stenosis ratio was increased to more than 70%, and the situation did not have significant difference after the application of remote displacement except the model with stenosis ration of 90%.ConclusionsThe result suggests that the rotatory manipulation does not have an obvious influence on the blood flow in the CoW when the stenosis of ICA is less than 90%, and this kind of manipulation is suggested to be a safe technique in most of the clinical applications.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis

Lin

Ma²,

Deng³

et al. 2015

Med Sci Monit

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“…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%

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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“…3,6,[10][11][12][13] Several individual reports describe embolic cerebral infarcts in patients with FPCA, while larger series by Yang et al and Arjal et al show an increased frequency of a ''causative'' FPCA ipsilateral to cerebral infarctions, as well as a greater predisposition to ischemic stroke in patients with FPCA. 2,14,[15][16][17][18][19][20] However, in another series of patients with PCA infarcts, de Monye´et al show no increased risk in patients with a FPCA. 3 In the largest series of patients with ischemic stroke examined for the presence of FPCA, Shaban et al conclude that although a FPCA may predispose to stroke mechanism, it is not associated with vascular distribution, stroke severity, or early outcome.…”

Section: Discussionmentioning

confidence: 92%

Endovascular intervention of acute ischemic stroke due to occlusion of fetal posterior cerebral artery

Amuluru

Ho²,

Al‐Mufti

et al. 2018

Interv Neuroradiol

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A fetal posterior cerebral artery (FPCA) is an anatomic variant in which the posterior cerebral artery is an embryological derivative of the internal carotid artery. Although most cases of ischemic strokes in patients with FPCAs involve embolic infarcts, emergent large vessel occlusion of a FPCA is extremely rare. We present two cases of successful endovascular intervention for emergent occlusion of a FPCA, one of which is only the second reported case of a mechanical thrombectomy of a FPCA. We review the embryology of FPCA, the controversy regarding its association with cerebral infarcts, and various approaches used in the treatment of such occlusive lesions.

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Internal carotid artery stenosis presenting as ipsilateral posterior cerebral artery ischaemic stroke: a lesson to be learnt

Cited by 7 publications

References 12 publications

Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis

Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis

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

Endovascular intervention of acute ischemic stroke due to occlusion of fetal posterior cerebral artery

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