High posterior cerebral artery flow predicts ischemia recurrence in patients with internal carotid artery occlusion

• Published in: Frontiers in neurology 2023-07, Vol.14, p.1193640-1193640
• Main Authors: Jud, Simon, Klövekorn, Robert, van Niftrik, Christiaan Hendrik Bas, Herzog, Lisa, Sebök, Martina, Schweizer, Juliane, Luft, Andreas R, Fierstra, Jorn, Wegener, Susanne
• Format: Article
• Language: English
• Subjects: collaterals; internal carotid artery occlusion; Neurology; posterior cerebral artery; recurrent stroke; transcranial duplex
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2023.1193640

Recurrent stroke is a dreaded complication of symptomatic internal carotid artery occlusion (ICAO). Transcranial Duplex (TCD)-derived increased flow velocity in the ipsilateral posterior cerebral artery (PCA)-P2 segment indicates activated leptomeningeal collateral recruitment and hemodynamic impairment. Leptomeningeal collaterals are pial vascular connections between the anterior and posterior vascular territories. These secondary collateral routes are activated when primary collaterals via the Circle of Willis are insufficient. Our goal was to test the TCD parameter PCA-P2 flow for prediction of ipsilateral ischemia recurrence. We retrospectively analyzed clinical and ultrasound parameters in patients with ICAO. Together with clinical variables, we tested systolic PCA-P2 flow velocity as predictor of a recurrent ischemic event using logistic regression models. Of 111 patients, 13 showed a recurrent ischemic event within the same vascular territory. Increased flow in the ipsilateral PCA-P2 on transcranial ultrasound (median and interquartile range [IQR]: 60 cm/s [IQR 26] vs. 86 cm/s [IQR 41],  =