Flow dynamics in acute ischemic stroke due to embolic occlusion of a fetal posterior cerebral artery treated with endovascular thrombectomy - report of two cases

Karl Matz; Andrei Apetroe; Andreas Chemelli; Cornelia Brunner; Christian Nasel

doi:10.1016/j.radcr.2022.01.025

Flow dynamics in acute ischemic stroke due to embolic occlusion of a fetal posterior cerebral artery treated with endovascular thrombectomy - report of two cases

Radiol Case Rep. 2022 Mar 24;17(5):1727-1733. doi: 10.1016/j.radcr.2022.01.025. eCollection 2022 May.

Authors

Karl Matz^{1

2}, Andrei Apetroe², Andreas Chemelli³, Cornelia Brunner⁴, Christian Nasel^{5

6}

Affiliations

¹ University of Continuing Education Krems, Department for Clinical Neurosciences and Preventive Medicine, 3500 Krems, Austria.
² Landes Klinikum Baden-Mödling, Neurological Departement, 2340 Mödling, Austria.
³ Landes Klinikum Baden-Mödling, Radiological Departement, Mödling, Austria.
⁴ University Clinic Tulln, Landsteiner Private University, Neurological Department, Tulln, Austria.
⁵ University Clinic Tulln, Landsteiner Private University, Radiological Departement, Tulln, Austria.
⁶ Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.

Abstract

The fetal variant of the posterior cerebral artery (fPCA) conserves a major blood flow from the anterior to the posterior cerebral circulation via a strong persistent caudal portion of the embryonic internal carotid artery. We present two cases where endovascular treatment in acute ischemic stroke was complicated by this flow diversion. Though direct thrombectomy of the fPCA using a stent retriever was feasible and successful in both cases outcome remained unfavourable due to a continuous redirection of embolic material into the posterior circulation. Knowledge of flow dynamics in a fPCA is important for endovascular treatment in acute ischemic stroke.

Keywords: Acute ischemic stroke; Cerebrovascular circulation; Fetal circle of Willis; Retriever; Stent; Thrombectomy.

Publication types

Case Reports