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. 2023;52(6):643-650.
doi: 10.1159/000529994. Epub 2023 Mar 15.

Prevalence and Incidence of Carotid-Fetal-Posterior Syndrome

Agneta Cruz-Rojas  1 , Thomas Gu  1 , Elisa Kellomäki  1 , Annika Nordanstig  2 , Allan J Fox  3 , Elias Johansson  1   4
Affiliations

Prevalence and Incidence of Carotid-Fetal-Posterior Syndrome

Agneta Cruz-Rojas et al. Cerebrovasc Dis. 2023.

Abstract

Introduction: Carotid-fetal-posterior (CFP) syndrome is a posterior cerebral artery (PCA) territory ischemic stroke/TIA caused by symptomatic ≥50% carotid stenosis or occlusion via fetal posterior communicating artery. We aimed to assess the incidence of CFP syndrome and prevalence of CFP syndrome among symptomatic ≥50% carotid stenosis or occlusion as these are unknown.

Methods: We reassessed consecutive CTAs from 4,042 persons and included locally admitted patients with ≥50% carotid stenosis or occlusion. These were assessed for symptoms and signs of possible posterior circulation stroke/TIA (suspicion of CFP syndrome). Among these, those with unilateral PCA territory stroke/TIA, ipsilateral stenosis, and fetal/fetal-type PCA were considered CFP syndrome.

Results: We included 208 locally admitted patients with ≥50% carotid stenosis or occlusion; 33 (16%) patients had suspicion of CFP syndrome, of which 3 (9%) had CFP syndrome. The prevalence of CFP syndrome was 2.9% of symptomatic ≥50% carotid stenosis or occlusion; incidence was 4.23 per 1,000,000 person-years. Also, we found a lower prevalence of CFP syndrome (0.9%, p = 0.047) among referred patients with symptomatic ≥50% carotid stenosis or occlusion than among locally admitted patients with symptomatic ≥50% carotid stenosis or occlusion.

Discussion/conclusion: CFP syndrome has a low incidence and low prevalence among symptomatic carotid stenosis cases. Given lower prevalence of CFP syndrome among referred cases than local, CFP syndrome seems susceptible to underdiagnosis. On the other hand, few cases with suspicion of CFP syndrome had CFP syndrome, why CFP syndrome also seems susceptible to overdiagnosis if detailed assessment is not employed.

Keywords: CT angiography; Carotid stenosis; Fetal posterior cerebral artery; Symptomatic carotid stenosis.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Study flowchart.
Fig. 2.
Fig. 2.
Three cases of CFP syndrome (first two has a single panel/row, the third has two panels/rows). All: plain CT head, CTA of the stenosis, and of the P1-P2-Pcom part of the Circle of Willis. Black arrow: stenosis. Black arrowhead: embolic occlusion. White arrow: ipsilateral Pcom. White arrowhead: P1. Black star: recent infarction (around or adjacent to the star). White star: occluded ICA.
See this image and copyright information in PMC

References

    1. Kolukısa M, Gürsoy AE, Kocaman G, Dürüyen H, Toprak H, Asil T. Carotid endarterectomy in a patient with posterior cerebral artery infarction: influence of fetal type PCA on atypical clinical course. Case Rep Neurol Med. 2015;2015:191202. 10.1155/2015/191202. - DOI - PMC - PubMed
    1. Hunter JM, Tehrani SK, Wood T, Geraghty R. Internal carotid artery stenosis presenting as ipsilateral posterior cerebral artery ischaemic stroke: a lesson to be learnt. BMJ Case Rep. 2013 Apr 22;2013:bcr2013008848. 10.1136/bcr-2013-008848. - DOI - PMC - PubMed
    1. Maras D, Tzormpatzoglou I, Papas TT, Papanas N, Kotsikoris I, Kotsiou S, et al. . Carotid endarterectomy in patients with foetal-type posterior circle of Willis: is there an indication for local anaesthesia? Vasa. 2011 Sep;40(5):404–7. 10.1024/0301-1526/a000138. - DOI - PubMed
    1. Mann L, Preece R, Haslam L, Paravastu SCV, Bulbulia RA, Kulkarni SR. Posterior cerebral circulation stroke secondary to foetal origin of posterior communicating artery: an indication for carotid endarterectomy. EJVES Vasc Forum. 2021;50:7–11. 10.1016/j.ejvsvf.2020.12.022. - DOI - PMC - PubMed
    1. Yang JH, Choi HY, Nam HS, Kim SH, Han SW, Heo JH. Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories. Cerebrovasc Dis. 2007;24(5):445–51. 10.1159/000108435. - DOI - PubMed

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