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Review
Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature
  1. Xintong Li1,
  2. Nitin Agarwal1,
  3. David R Hansberry1,
  4. Charles J Prestigiacomo1,2,3,
  5. Chirag D Gandhi1,2
  1. 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  3. 3Department of Neurology and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr C D Gandhi, Department of Neurological Surgery, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07101-1709, USA; gandhich{at}njms.rutgers.edu

Abstract

The artery of Percheron (AOP) is a rare anatomic variant of the paramedian thalamic–mesencephalic arterial supply, arising as a solitary arterial trunk from the P1 segment of the posterior cerebral artery. Its occlusion, commonly caused by cardioembolism, leads to distal bilateral paramedian thalamic ischemia, oftentimes affecting the midbrain and/or the anterior thalamus. AOP occlusion presents with a clinical triad of altered mental status, vertical gaze palsy, and memory impairment, along with other associated symptoms. Digital subtraction angiography is effective for detecting AOP, while diffusion weighted MRI is best for diagnosis of its occlusion. Our extensive literature search sought to determine the best forms of treatment for uncomplicated AOP occlusion, with the inclusion criterion of implementation of medical treatment or other forms of therapy in patient recovery from this condition. We conclude that intravenous heparin and thrombolysis with tissue plasminogen activator are effective firstline treatment options for emergent AOP occlusion followed by a prescription of long term anticoagulants, while non-emergent cases without midbrain involvement could be treated through rehabilitation and continual monitoring by medical staff. Clinical trials of higher power are needed for a more comprehensive analysis of the treatment options for AOP occlusion.

  • Thrombolysis
  • Thrombectomy
  • Stroke
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