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The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction

D F Schomer1, M P Marks, G K Steinberg

  • 1Department of Radiology, Stanford University Medical Center, CA 94305-5105.

The New England Journal of Medicine
|June 2, 1994
PubMed

Insights

A small or absent posterior communicating artery increases stroke risk in internal carotid artery occlusion patients. This finding highlights the importance of collateral circulation in preventing ischemic infarction.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Internal carotid artery occlusion compromises cerebral blood flow.
  • Collateral circulation, primarily via the Circle of Willis, is variable.
  • Identifying protective collateral patterns is crucial for preventing ischemic infarction.

Purpose of the Study:

  • To investigate the relationship between collateral pathway anatomy and watershed infarction risk in internal carotid artery occlusion.
  • To identify specific collateral features that may protect against ischemic stroke.

Main Methods:

  • Evaluated 29 patients with internal carotid artery occlusion using MRI and 3D phase-contrast angiography.
  • Assessed four key collateral pathways: anterior cerebral artery, posterior communicating artery, ophthalmic artery, and leptomeningeal collaterals.
  • Correlated collateral pathway characteristics with the presence or absence of deep white matter watershed infarction.

Main Results:

  • The diameter and patency of the ipsilateral posterior communicating artery were significantly associated with infarction risk.
  • Posterior communicating arteries ≥ 1 mm in diameter correlated with an absence of watershed infarction (P < 0.001).
  • Smaller (< 1 mm) or absent posterior communicating arteries were linked to a higher incidence of watershed infarcts.

Conclusions:

  • A small (< 1 mm) or absent ipsilateral posterior communicating artery is a significant risk factor for ischemic cerebral infarction.
  • This anatomical variation impacts the brain's ability to compensate for internal carotid artery occlusion.
  • Understanding these collateral pathways can aid in stroke risk stratification.
Abstract

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