Skip to main content

Advertisement

SpringerLink
Log in

Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke?

A study with 16-multidetector-row CT angiography

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background and purpose

Fetal origin of the posterior cerebral artery (PCA) is not uncommon. Whether patients with this anomaly have a higher risk of ischemic stroke in the territory of the PCA is not known. The clinical benefit of screening for a fetal origin in patients with TIA or stroke in the territory of the PCA and an ipsilateral atherosclerotic carotid stenosis is not clear. This study assessed the frequency of a fetal origin of the PCA in patients with a TIA or infarct in the territory of the PCA with 16-multidetector-row CT angiography (CTA).

Methods

82 patients (52 male; mean age = 64; range 19 to 90 years) with isolated homonymous hemianopia and/or a PCA infarct underwent CTA of the carotid artery and circle of Willis.

Results

A fetal origin of the PCA at the symptomatic side was present in 14 patients (17 %) and at the asymptomatic side in 18 patients (22%) (OR: 0.7; 95 % CI: 0.3 to 1.7). Severity of stenosis (NASCET criteria) of the ICA at the symptomatic side was < 30%, 30–49% and ≥ 50% in 72, 2 and 8 patients, respectively. Number and frequency of a fetal origin in these groups were 12 (17 %), 0 (0%) and 2 (25 %), respectively. There was no association between a severe carotid stenosis and a fetal origin of the PCA at the symptomatic side.

Conclusion

This study does not provide arguments for an increased risk of ischemic stroke in the territory of the PCA in patients with a fetal origin of the PCA. A few patients with a TIA or infarct in the territory of the PCA have a fetal origin of the PCA in combination with a high-grade stenosis of the ipsilateral ICA, but not more often than one would expect from chance. Nevertheless, these patients may benefit from carotid endarterectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    Article  Google Scholar 

  2. European Carotid Surgery Trialists’ Collaborative Group (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29 %) carotid stenosis. Lancet 337:1235–1243

    Article  Google Scholar 

  3. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ (2005) An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 58:688–697

    Article  PubMed  Google Scholar 

  4. Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry: analysis of 1, 000 consecutive patients with first stroke. Stroke 19:1083–1092

    PubMed  CAS  Google Scholar 

  5. Brandt T, Thie A, Caplan LR, Hacke W (1995) Infarcts in the brain areas supplied by the posterior cerebral artery, Clinical aspects, pathogenesis and prognosis. Nervenarzt 66:267–274

    PubMed  CAS  Google Scholar 

  6. Cohen SN (1989) Occipital infarction with hemianopsia from carotid occlusive disease. Stroke 20:1433–1434

    PubMed  CAS  Google Scholar 

  7. de Monye C, Cademartiri F, de Weert TT, Siepman DA, Dippel DW, van Der Lugt A (2005) Sixteen-detector row CT angiography of carotid arteries: comparison of different volumes of contrast material with and without a bolus chaser. Radiology 237:555–562

    Article  PubMed  Google Scholar 

  8. Fisher CM (1986) The posterior cerebral artery syndrome. Can J Neurol Sci 13:232–239

    PubMed  CAS  Google Scholar 

  9. Fleischmann D (2002) Present and future trends in multiple detector-row CT applications: CT angiography. Eur Radiol 12(Suppl 2):S11–S15

    Article  PubMed  Google Scholar 

  10. Graf J, Skutta B, Kuhn FP, Ferbert A (2000) Computed tomographic angiography findings in 103 patients following vascular events in the posterior circulation: potential and clinical relevance. J Neurol 247:760–766

    Article  PubMed  CAS  Google Scholar 

  11. Hollingworth W, Nathens AB, Kanne JP, Crandall ML, Crummy TA, Hallam DK, Wang MC, Jarvik JG (2003) The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol 48:88–102

    Article  PubMed  Google Scholar 

  12. Jongen JC, Franke CL, Soeterboek AA, Versteege CW, Ramos LM, van Gijn J (2002) Blood supply of the posterior cerebral artery by the carotid system on angiograms. J Neurol 249:455–460

    Article  PubMed  Google Scholar 

  13. Kleihues P, Hizawa K (1966) The infarct of the posterior cerebral artery: pathogenesis and topographical relationship to the visual cortex. Arch Psychiatr Nervenkr 208:263–284

    PubMed  CAS  Google Scholar 

  14. Kuker W, Mull M, Block F, Thron A (1997) Carotid artery dissections presenting as isolated posterior cerebral artery infarctions. J Neurol 244:324–327

    Article  PubMed  CAS  Google Scholar 

  15. Nederkoorn PJ, Mali WP, Eikelboom BC, Elgersma OE, Buskens E, Hunink MG, Kappelle LJ, Buijs PC, Wust AF, van der Lugt A, van der Graaf Y (2002) Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke 33:2003–2008

    Article  PubMed  Google Scholar 

  16. Pedroza A, Dujovny M, Artero JC, Umansky F, Berman SK, Diaz FG, Ausman JI, Mirchandani HG (1987) Microanatomy of the posterior communicating artery. Neurosurgery 20:228–235

    Article  PubMed  CAS  Google Scholar 

  17. Pessin MS, Kwan ES, Scott RM, Hedges TR 3rd (1989) Occipital infarction with hemianopsia from carotid occlusive disease. Stroke 20:409–411

    PubMed  CAS  Google Scholar 

  18. Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR 3rd, Caplan LR (1987) Clinical features and mechanism of occipital infarction. Ann Neurol 21:290–299

    Article  PubMed  CAS  Google Scholar 

  19. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–116

    Article  PubMed  CAS  Google Scholar 

  20. Saeki N, Rhoton AL Jr (1977) Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 46:563–578

    PubMed  CAS  Google Scholar 

  21. Steinke W, Mangold J, Schwartz A, Hennerici M (1997) Mechanisms of infarction in the superficial posterior cerebral artery territory. J Neurol 244:571–578

    Article  PubMed  CAS  Google Scholar 

  22. Tulleken CA, Luiten ML (1987) The basilar artery bifurcation: microscopical anatomy. Acta Neurochir (Wien) 85:50–55

    Article  CAS  Google Scholar 

  23. van der Lugt A, Buter TC, Govaere F, Siepman DA, Tanghe HL, Dippel DW (2004) Accuracy of CT angiography in the assessment of a fetal origin of the posterior cerebral artery. Eur Radiol 14:1627–1633

    PubMed  CAS  Google Scholar 

  24. van Raamt AF, Mali WP, van Laar PJ, van der Graaf Y (2006) The fetal variant of the Circle ofWillis and its influence on the cerebral collateral circulation. Cerebrovasc Dis 22:217–224

    Article  PubMed  Google Scholar 

  25. Velthuis BK, van Leeuwen MS, Witkamp TD, Ramos LM, Berkelbach van der Sprenkel JW, Rinkel GJ (2001) Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography. J Neurosurg 95:206–212

    Article  PubMed  CAS  Google Scholar 

  26. Wardlaw JM, Chappell FM, Best JJ, Wartolowska K, Berry E (2006) Noninvasive imaging compared with intraarterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. Lancet 367:1503–1512

    Article  PubMed  CAS  Google Scholar 

  27. Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR (1999) Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. Arch Neurol 56:824–832

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Radiology, Erasmus MC, University Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands

    C. de Monyé MD, M. L. Dijkshoorn, H. L. J. Tanghe MD & A. van der Lugt MD, PhD

  2. Dept. of Neurology, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015, GD Rotterdam, The Netherlands

    D. W. J. Dippel MD, PhD & T. A. M. Siepman MD

Authors
  1. C. de Monyé MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. W. J. Dippel MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. A. M. Siepman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. L. Dijkshoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. L. J. Tanghe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. van der Lugt MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. van der Lugt MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Monyé, C., Dippel, D.W.J., Siepman, T.A.M. et al. Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke?. J Neurol 255, 239–245 (2008). https://doi.org/10.1007/s00415-008-0699-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-008-0699-8

Key words

Search

Navigation