Why it’s important to know Percheron’s artery: solitary carotid stenosis as a unique cause of anterior, posterior and bithalamic ischemia

Abstract

Sirs: Embolic infarctions secondary to internal carotid artery (ICA) stenosis are usually located in the vascular territories of the anterior (ACA) and middle (MCA) cerebral arteries. In rare cases, if a fetal-type posterior circle of Willis is present, the territory of the posterior cerebral artery (PCA) may additionally be involved. Here we present a patient with subtotal ICA stenosis who suffered multiple embolic infarctions involving not only the territories of the ipsilesional recurrent artery of Heubner, the MCA and PCA, but also the ipsilesional and contralesional inferomedial thalami. The entire stroke pattern may be explained best by the rare coincidence of two anatomical variants: (1) the presence of a Percheron artery (2) arising from a fetal-type posterior circles of Willis (FTP). Case report