Artery-to-artery embolism causing stroke in the posterior circulation

Area of Science:

• Neurology
• Vascular Neurology
• Cerebrovascular Disease

Background:

• Vertebral artery (VA) to posterior cerebral artery (PCA) embolism is a significant cause of posterior circulation stroke.
• Understanding the clinical features and sources of embolism is crucial for diagnosis and management.

Observation:

• This study reports on 12 patients with strokes attributed to VA-to-PCA embolism.
• Occipital infarction was a common finding, often accompanied by prominent or transient brainstem ischemic symptoms.
• Visual field abnormalities were frequently observed, appearing early or delayed after symptom onset.

Findings:

• Radiographic studies identified extracranial or intracranial VA disease, or combined segment occlusion, as the source of emboli in 11 patients.
• Mural thrombus in the VA or distal PCA branch occlusion was visualized in five patients.
• The pattern of embolism directly correlated with specific clinical presentations and infarct locations.

Implications:

• These findings highlight the importance of evaluating the vertebral arteries in patients presenting with posterior circulation stroke symptoms.
• Identifying VA disease as the source of artery-to-artery embolism can guide targeted therapeutic strategies.
• Further research into VA embolism mechanisms may improve stroke prevention and treatment outcomes.