What is the role of proximal vertebrobasilar artery disease in the etiology of posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Atheromatous disease may be found within the vertebral artery in patients with posterior circulation ischemia and may result in stenosis or occlusion of that proximal vessel. This may result in hypoperfusion or artery-to-artery embolism involving the PCAs.

Dissection of the vertebral arteries may result from trauma or occur spontaneously and result in arterial embolization. The vertebral arteries are uniquely prone to dissection due to their intracanalicular course within the vertebral bodies. (Some authorities have expressed concern that chiropractic manipulation of the neck may cause vertebral artery dissection.) PCA stroke secondary to vertebral artery dissection may occur when thrombus forms at an intimal tear and embolizes distally or when the dissection results in vessel stenosis/occlusion, with subsequent vascular stasis and embolism.

Intrinsic basilar atheromatous disease may result in misery perfusion or artery-to-artery embolization in the PCA distribution.

Intrinsic PCA stenosis from atherosclerosis is a less common, but recognized, cause of stroke.

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