From the Research
PICA strokes are primarily caused by atherosclerosis, hypertension, and diabetes mellitus, with additional risk factors including smoking, advanced age, hyperlipidemia, and atrial fibrillation, as well as genetic disorders, hypercoagulable states, and inflammatory conditions 1.
Risk Factors for PICA Stroke
The following are some of the key risk factors for PICA stroke:
- Atherosclerosis: damages blood vessel walls, promoting plaque formation and increasing stroke risk
- Hypertension: the most important modifiable risk factor for stroke, contributing to small vessel arteriolosclerosis and large artery athero-thromboembolism
- Diabetes mellitus: contributes to plaque buildup and increases stroke risk
- Smoking: accelerates atherosclerosis and increases stroke risk
- Advanced age: vascular changes accumulate over time, increasing stroke risk
- Hyperlipidemia: contributes to plaque buildup and increases stroke risk
- Atrial fibrillation: generates emboli that can travel to the PICA
- Previous stroke or TIA history: indicates underlying vascular disease
- Obesity: increases stroke risk
- Physical inactivity: increases stroke risk
- Excessive alcohol consumption: increases stroke risk
- Drug abuse: especially cocaine and amphetamines, which cause vasoconstriction
- Genetic disorders: such as CADASIL and Fabry disease, which increase risk
- Hypercoagulable states: such as protein C/S deficiencies and antiphospholipid syndrome, which increase risk
- Inflammatory conditions: including vasculitis and arterial dissection, which can directly affect the vertebral artery and PICA
- Sleep apnea: causes intermittent hypoxia and blood pressure fluctuations, increasing stroke risk
- Vertebral artery anatomical variations or compression from cervical spondylosis: significant risk factors specific to posterior circulation strokes
Importance of Early Identification and Treatment
Early identification and treatment of PICA stroke are crucial to minimize the impact of the stroke and improve outcomes 2. This includes prompt recognition of stroke symptoms, rapid transportation to a stroke center, and timely administration of thrombolytic therapy or endovascular intervention. Additionally, management of patient physiologic parameters, such as blood pressure and glucose levels, is important to minimize infarct volumes and improve outcomes. Secondary prevention strategies, including antiplatelet therapy and statin therapy, are also essential to prevent recurrent stroke.