The Time Course of Percheron Artery Ischemic Coma on Imaging: A Retrospective Cohort Study

Abstract

Background: We investigated the time course of awakening events in acute Percheron artery ischemic coma (PAIC), which was previously unknown. Methods: Patients who had newly identified acute PAIC in 2010-2013 and had not received thrombolytic therapy were enrolled prospectively. The lesion sizes of PAIC were measured using diffusion-weighted imaging (DWI). The time course of PAIC was also assessed using the Glasgow Coma Scale. Findings: Ninety-three patients met the inclusion criteria, of whom 63 and 30 had transient PAIC and persistent PAIC, respectively. The time course of awakening events in persistent PAIC decreased over time, with large lesions in the bilateral paramedian thalamus/rostral midbrain on DWI almost in all patients and the artery of infarction either at Percheron artery or at a variant of the top of basilar artery; whereas awakening events in transient PAIC increased over time, with small or dot-like lesions in the paramedian thalamus/rostral midbrain in 30.2% cases, and the rest in naturally recanalization of infarcts or TIA. Lesion volumes were larger for persistent PAIC than for transient PAIC (median, 2.4 cm3 vs. 0.03 cm3, P <0.0001). In a proportional hazards ratio (HR) analysis, lesion volume was associated with mortality (HR, 1.8; 95% confidence interval[CI],1.096-2.810). Transient PAIC was associated with much better survival than persistent PAIC (HR, 13.5; 95% CI, 10.29-29.31). Interpretation: The time course of awakening events in transient PAIC differed from that in persistent PAIC. Persistent PAIC was associated with large ischemic lesions in the paramedian thalamus /rostral midbrain, and with high mortality. Funding Statement: This work is supported by a grant from National Clinical Key Specialty Construction Project (20160001), the Medical Research Council, affiliated Shuyang Hospital of Xuzhou Medical University, China. Declaration of Interests: Authors have no conflict of interest. Ethics Approval Statement: This study was approved with a waiver of informed consent by the Ethical Committee of the Shuyang People’s Hospital.