Chakraborty Uddalak, Gupta Subhadeep, Dutta Arpan, Ray Biman Kanti, Gandhi Ashok, Srivastava Trilochan, Kumar Rahul, Das Deep
Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Annex-1, Kolkata, West Bengal, India.
Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India.
Ann Indian Acad Neurol. 2023 May-Jun;26(3):261-267. doi: 10.4103/aian.aian_953_22. Epub 2023 Apr 20.
Intracranial arterial dissections commonly involve the vertebrobasilar system leading to subarachnoid hemorrhage (SAH) or cerebral infarction attributable to a dissecting aneurysm of the vessel or occlusion of the lumen depending on the depth of dissection. However, isolated posterior cerebral artery dissections (PCADs) are rare and sparsely reported in the literature.
A retrospective multicentric observational study was carried out after collecting data from 14 patients admitted with PCAD in three hospitals of Kolkata, Jaipur, and Patna within the period of July 2021 to June 2022.
The median age of the population was 48.5 years, and 64.28% were females. SAH was the most common presentation with dissecting aneurysms in all patients barring one, who presented with a left occipital infarct consequent to ipsilateral PCAD. Among the 14 patients, three patients denied endovascular intervention and were lost to follow-up; one patient with an occipital infarct and another patient with a dissecting left P3 aneurysm, which underwent spontaneous thrombosis, were managed conservatively. Among the nine patients scheduled for endovascular coiling, one patient succumbed before intervention and one patient succumbed to sepsis in the postoperative period. A complete recovery was noted in six patients, whereas residual neurodeficits were present in three patients. Among the six patients who had an uneventful recovery at the end of 3 months, five patients had an endovascular intervention.
PCAD may present with large-scale neurodeficits and is associated with high morbidity and mortality, hence necessitating prompt management. Conservative management is preferable for consequent infarcts, whereas endovascular management is desirable in cases of dissecting aneurysms, which usually tend to have a favorable outcome if intervened early.
颅内动脉夹层通常累及椎基底动脉系统，导致蛛网膜下腔出血（SAH）或脑梗死，这取决于夹层的深度，可归因于血管夹层动脉瘤或管腔闭塞。然而，孤立性大脑后动脉夹层（PCAD）很少见，文献报道也很稀少。
2021年7月至2022年6月期间，在加尔各答、斋浦尔和巴特那的三家医院收集了14例因PCAD入院患者的数据后，进行了一项回顾性多中心观察性研究。
患者的中位年龄为48.5岁，64.28%为女性。SAH是最常见的表现，除1例因同侧PCAD导致左侧枕叶梗死外，所有患者均有夹层动脉瘤。在这14例患者中，3例患者拒绝血管内介入治疗并失访；1例枕叶梗死患者和另1例左侧P3夹层动脉瘤自发血栓形成的患者接受了保守治疗。在计划进行血管内栓塞的9例患者中，1例患者在干预前死亡，1例患者在术后死于败血症。6例患者完全康复，3例患者有残留神经功能缺损。在3个月结束时恢复顺利的6例患者中，5例患者接受了血管内介入治疗。
PCAD可能伴有大规模神经功能缺损，且发病率和死亡率较高，因此需要及时处理。对于继发梗死，保守治疗更可取，而对于夹层动脉瘤，血管内治疗是理想的选择，如果早期干预，通常预后良好。
