Mechanisms of Stroke in Patients with Fetal Posterior Cerebral Artery

Abstract

ObjectivesThe fetal-type posterior cerebral artery (FTP) is a normal variation of the posterior cerebral artery (PCA), occurring in 3–36% of general population. The effects of the FTP in stroke mechanisms remain debatable. We aimed to investigate the differences in stroke mechanisms and lesion locations between patients with and without FTP. MethodsA total of 394 patients with PCA territory stroke were divided into those with PCA ischemic stroke associated with ipsilateral FTP and those without. The baseline characteristics, vascular risk factors, infarct pattern, stroke location, stroke etiology, and the diameter of P1 in patients without FTP or posterior communicating artery (PcoA) in patients with FTP were investigated. ResultsAmong the 394 patients, 52 (13.2%) PCA stroke patients with ipsilateral FTP were enrolled. Patients with FTP, in comparison with those without, had a higher frequency of deep infarct pattern (69.2% vs. 47.1%, P=0.012), small vessel occlusion (51.9% vs. 28.9%, P=0.009), ventrolateral thalamic involvement (65.4% vs. 49.1%, P=0.042), and a lower frequency of cardiac embolism (9.6% vs. 24.0%, P=0.009). The diameter of P1 in patients without FTP was larger than that of PcoA in patients with FTP (2.1 ± 0.3 mm vs. 1.6 ± 0.2 mm, P <0.001). ConclusionsThe stroke mechanisms, infarct pattern, and the location of the stroke were different between patients with and without FTP. PCA stroke patients with FTP more often had small vessel occlusion and ventrolateral thalamic involvement. These results are probably associated with difference in the hemodynamic status according to the presence of FTP.