Mann Lydia, Preece Ryan, Haslam Liz, Paravastu Sharath C V, Bulbulia Richard A, Kulkarni Sachin R
Gloucestershire and Swindon Vascular Network, Cheltenham General Hospital, UK.
EJVES Vasc Forum. 2020 Dec 16;50:7-11. doi: 10.1016/j.ejvsvf.2020.12.022. eCollection 2021.
Posterior cerebral circulation strokes are most commonly caused by posterior vasculature thrombosis, cardiac emboli, or arterial dissection. However, the foetal origin of the posterior communicating artery is an anatomical variant of the cerebral circulation that results in communication between the internal carotid and posterior cerebral circulation. Therefore, rarely this can result in posterior cerebral territory infarction from internal carotid artery thrombo-embolism. This is the report of a case in which a patient suffered posterior circulation stroke secondary to this anatomical variation of the circle of Willis.
A 71 year old male patient was admitted to the stroke team with seizures, headache, and confusion. Examination revealed a left sided homonymous hemianopia. Diffusion weighted magnetic resonance imaging (MRI) of the brain 36 hours into his admission revealed an acute right posterior circulation infarct with extensive haemorrhagic transformation. Duplex ultrasound three days later revealed a heavily calcified right internal carotid artery mixed echogenicity plaque with 80%-90% stenosis. Subsequent computed tomography angiography showed a large right foetal variant posterior communicating artery. Following improvement in functional status, the patient underwent uneventful carotid endarterectomy to reduce risk of future stroke.
In patients presenting with posterior circulation infarction, clinicians should consider embolism from an atheromatous internal carotid artery via the variant foetal origin of posterior communicating artery. If detected, consideration should be given to undertaking carotid endarterectomy to reduce future stroke risk if no other source is detected.
大脑后循环卒中最常见的病因是后循环血管血栓形成、心脏栓子或动脉夹层。然而，后交通动脉的胚胎起源是脑循环的一种解剖变异，导致颈内动脉和大脑后循环之间存在交通。因此，这种情况很少会因颈内动脉血栓栓塞导致大脑后循环区域梗死。本文报告了一例因 Willis 环的这种解剖变异继发后循环卒中的病例。
一名 71 岁男性患者因癫痫发作、头痛和意识模糊被收治入卒中治疗团队。检查发现左侧同向性偏盲。入院 36 小时后脑部的弥散加权磁共振成像（MRI）显示急性右侧后循环梗死并伴有广泛出血转化。三天后的双功超声显示右侧颈内动脉有严重钙化的混合回声斑块，狭窄率为 80%-90%。随后的计算机断层血管造影显示右侧有较大的胚胎型后交通动脉变异。在功能状态改善后，患者接受了顺利的颈动脉内膜切除术以降低未来卒中风险。
对于出现后循环梗死的患者，临床医生应考虑粥样硬化的颈内动脉通过胚胎型后交通动脉变异导致的栓塞。如果检测到这种情况，在未发现其他栓子来源时，应考虑进行颈动脉内膜切除术以降低未来卒中风险。
