Mechanical thrombectomy for acute fetal posterior cerebral artery occlusion with a hidden unruptured cerebral aneurysm: illustrative case

Ishikawa, Kohei; Endo, Hideki; Shindo, Koichiro; Nomura, Ryota; Oka, Koji; Nakamura, Hirohiko

doi:10.3171/case22291

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Fetal intracranial aneurysms of other vessels are extremely rare. To the best of our knowledge, prenatal diagnosis of aneurysm of the posterior cerebral artery (APCA) and its natural intrauterine course of the disease has never been reported, whereas the fetal-type posterior cerebral artery abnormalities or aneurysm is a common neurovascular variant in adult [ 2 – 4 ]. Though never been studied, APCA can theoretically cause fetal heart failure as manifested by hydrops with a high mortality rate as described in VGAM [ 5 ], whereas intracranial hemorrhage is a rare finding in VGAM [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prenatal features of aneurysm of the posterior cerebral artery: a case report

Chaksuwat,

Jatavan,

Ake-sittipaisarn

et al. 2023

BMC Pregnancy Childbirth

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Background Fetal cerebral aneurysm other than aneurysm of vein of Galen aneurysmal malformation (VGAM) is extremely rare. This report describes prenatal features of aneurysm of the posterior cerebral artery (APCA) with rapid progression and its natural intrauterine course of the disease, which has never been reported. Case presentation This is the first report of prenatal features of APCA, detected at 34–36 weeks of gestation, simulating choroid plexus cyst or arachnoid cyst. The diagnosis was based on color flow ultrasound with tracing along the course of cerebral arteries. Also, rendered 3D color flow ultrasound was helpful in demonstrating course of the vessels feeding the aneurysm and supporting the diagnosis. The aneurysm showed nature of rapidly progressive changes, leading to leakage resulting in intracerebral and intraventricular hemorrhage as well as high output state associated with anemia. Prenatal diagnosis and management are very challenging. This case ended up with planned delivery at 37 weeks, giving birth to a surviving male newborn, weighing 2600 g. The neonatal CT brain scans and CTA confirmed the prenatal findings. The prognosis was relatively poor because of extensive intracerebral hemorrhage with severe hydrocephalus and brain midline shift. The couple opted for neonatal palliative care without neurosurgical correction. Conclusion This study demonstrate that the most important tool for prenatal diagnosis is color Doppler ultrasound, which will demonstrate turbulent blood flow. Three-dimension color Doppler ultrasound is helpful in supporting the diagnosis. The case presented here suggests that the disease has a natural course of rapid progression and massive brain destruction or high output congestive heart failure can be expected.

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Section: Introductionmentioning

confidence: 99%

Prenatal features of aneurysm of the posterior cerebral artery: a case report

Chaksuwat,

Jatavan,

Ake-sittipaisarn

et al. 2023

BMC Pregnancy Childbirth

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Reperfusion Therapy in Patients with Acute Stroke with the Willis Polygon Variant – A Fetal Posterior Cerebral Artery

Acır,

Erdoğan,

Yayla

2023

Neurological Sciences and Neurophysiology

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Aim: The Willis polygon variant, specifically the presence of a fetal posterior cerebral artery (fPCA), can have implications for the treatment and prognosis of patients with acute stroke. This study aimed to investigate the effect of fPCA variations on treatment, follow-up, and prognosis in patients with acute stroke who underwent reperfusion therapies. Materials and Methods: The study analyzed a total of 62 patients, including 33 without any posterior system variant (normal group) and 29 with only the fPCA variant (variant group). Demographic characteristics, clinical features, and computed tomography (CT) findings were compared between the two groups. Treatment methods, acute stroke therapies, and clinical outcomes were evaluated. Results: No significant differences were observed in age, sex, smoking status, or comorbidities between the normal and fPCA groups. Cardiac parameters were similar between the groups. Treatment approaches, artery territories, acute stroke therapies, and time intervals did not differ significantly between the two groups. The National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and CT findings were also similar between the groups. A significant difference was observed in the presence of hemorrhage at 24 h, with higher rates in the normal group. Conclusion: The presence of fPCA does not significantly influence age-related risk factors or comorbidities in patients with acute stroke. Treatment approaches and clinical outcomes were similar regardless of the presence of fPCA, except for a higher risk of hemorrhage in the normal group. The lateral status of the variants did not significantly impact the distribution of risk scores and CT findings.

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The Effect of Posterior Communicating Artery and Fetal Posterior Cerebral Artery Anomalies on Prognosis in Endovascular and Thrombolytic Therapy Patients

Erdoğan,

Acır,

Kurtpınar

et al. 2024

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Objective: Acute reperfusion therapy is a critical intervention for stroke patients with the aim of restoring blood flow. The presence of anatomical anomalies, such as fetal posterior cerebral artery (fPCA) and posterior communicating artery (PCOM) variations, can impact treatment outcomes and patient prognosis. This study aimed to assess the potential influence of these anomalies on patients undergoing acute reperfusion therapy.Materials and Methods: Demographic characteristics of patients who underwent acute reperfusion therapy for stroke were considered among three distinct groups: the PCOM group, fPCA group, and control group. The demographic attributes examined for each group included gender distribution, mean age, presence of comorbidities, thrombolysis in cerebral infarction, national institutes of health stroke scale (NIHSS), and European cooperative acute stroke study II (ECASS II) scores. The significance of differences in these attributes among the groups was assessed. Results:The study included a total of 106 patients: 42 patients in the PCOM group, 31 patients in the fPCA group, and 33 patients in the control group. No significant differences in demographic data were observed among the groups. The greatest decrease in NIHSS at the 24 th hour was observed in the PCOM group, whereas the least decrease on day 7 was observed in the fPCA group. No differences were detected in the NIHSS values on the 24 th hour and 7 th day among the groups. When the 24 th hour computed tomography scans of the groups were evaluated according to the ECASS II criteria, no significant differences were observed among the groups. Hemorrhage was not observed in 52.4% of patients in the PCOM group and 66.7% of patients in the control group. Conclusion:The impact of fPCA and PCOM anomalies on patients undergoing acute reperfusion therapy for stroke was evaluated. Although no significant demographic differences were found among the groups, the study highlights the importance of further research to better understand their potential impact on treatment outcomes.

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Mechanical thrombectomy for acute fetal posterior cerebral artery occlusion with a hidden unruptured cerebral aneurysm: illustrative case

Cited by 3 publications

References 9 publications

Prenatal features of aneurysm of the posterior cerebral artery: a case report

Prenatal features of aneurysm of the posterior cerebral artery: a case report

Reperfusion Therapy in Patients with Acute Stroke with the Willis Polygon Variant – A Fetal Posterior Cerebral Artery

The Effect of Posterior Communicating Artery and Fetal Posterior Cerebral Artery Anomalies on Prognosis in Endovascular and Thrombolytic Therapy Patients

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