What are the management and treatment options for a patient with left posterior cerebral artery (PCA) fetal origin?

From the Guidelines

Management of a patient with left posterior cerebral artery (PCA) fetal origin focuses on stroke prevention and addressing any associated symptoms. The primary treatment approach includes antiplatelet therapy with aspirin 81-325 mg daily or clopidogrel 75 mg daily for stroke prevention, as supported by guidelines for patients with atherosclerotic disease 1. Blood pressure control is essential, targeting levels below 140/90 mmHg using medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics as appropriate for the individual patient. Cholesterol management with statins (such as atorvastatin 20-80 mg or rosuvastatin 10-40 mg daily) is recommended to achieve LDL levels below 70 mg/dL. Lifestyle modifications including smoking cessation, limited alcohol consumption, regular exercise, and a Mediterranean or DASH diet are important complementary measures. Regular neurological monitoring with imaging studies (MRI/MRA) every 1-2 years is advised to assess for changes. Fetal PCA origin is an anatomical variant where the posterior cerebral artery originates from the internal carotid artery rather than the basilar artery, occurring in approximately 20-30% of the population. This variant can alter blood flow dynamics and potentially increase stroke risk in the posterior circulation territory, particularly if atherosclerotic disease develops in the carotid system, as it would affect both anterior and posterior circulation simultaneously. Key considerations in management include:

• Monitoring for signs of atherosclerotic disease and its complications
• Aggressive management of risk factors for atherosclerosis
• Regular follow-up with a healthcare provider to adjust the treatment plan as needed
• Education on the importance of lifestyle modifications and adherence to prescribed medications. Given the potential for increased stroke risk, close monitoring and aggressive management of risk factors are crucial 1. The most recent guidelines emphasize the importance of individualized care and consideration of the patient's overall health status and preferences in making treatment decisions 1. In the absence of specific guidelines for fetal PCA origin, management is guided by principles of stroke prevention and cardiovascular risk reduction 1. Overall, a comprehensive approach to management, including medical therapy, lifestyle modifications, and regular monitoring, is essential for optimizing outcomes in patients with left posterior cerebral artery fetal origin.

From the Research

Management and Treatment Options

The management and treatment options for a patient with left posterior cerebral artery (PCA) fetal origin are varied and depend on the specific clinical presentation.

• Endovascular intervention, such as mechanical thrombectomy, is a viable treatment option for acute occlusion of the fetal posterior cerebral artery 2, 3.
• The decision to perform endovascular intervention should be made on a case-by-case basis, taking into account the patient's clinical presentation, imaging findings, and overall health status 3.
• Medical management, including antithrombotic therapy and supportive care, may also be appropriate for some patients with fetal posterior cerebral artery occlusion 3.

Diagnostic Considerations

• The diagnosis of fetal posterior cerebral artery occlusion can be challenging, and a high index of suspicion is necessary to make the diagnosis 3.
• Imaging studies, such as cerebral angiogram and magnetic resonance imaging (MRI), can be helpful in diagnosing fetal posterior cerebral artery occlusion 3.
• The presence of a fetal-type posterior cerebral artery can provide unique challenges in the identification and treatment of cerebrovascular disease or a cerebrovascular accident 4.

Clinical Significance

• The fetal origin of the posterior cerebral artery is a frequent vascular variant, occurring in 11-29% of the population 5.
• The presence of a fetal-type posterior cerebral artery can impact cerebral blood flow, cerebrovascular reserve, and static functional connectivity 5.
• Understanding the embryological origins and clinical significance of fetal posterior cerebral artery variants is essential for providing optimal care for patients with these conditions 6, 4.