Management of Posterior Cerebral Artery Stenosis

Introduction to PCA Stenosis

• The American College of Cardiology and other societies define PCA stenosis as atherosclerotic narrowing of the posterior cerebral artery, a major intracranial vessel supplying the occipital lobe and portions of the temporal lobe 1, 2, 3

Appropriate Management for PCA Stenosis

• The American Heart Association recommends aggressive antiplatelet therapy with aspirin 75-325 mg daily as the cornerstone of treatment to prevent myocardial infarction and ischemic events in patients with PCA stenosis 1, 2, 3
• Intensive atherosclerotic risk factor modification including blood pressure control, lipid management, smoking cessation, and diabetes management is mandatory for patients with PCA stenosis, as recommended by the American College of Cardiology 1, 2, 3

Imaging Surveillance Strategy

• The American College of Cardiology recommends serial non-invasive imaging with MRA or CTA to assess progression of atherosclerotic disease and exclude development of new lesions in the posterior circulation in patients with PCA stenosis 2, 3
• MRA or CTA is specifically recommended over ultrasound for evaluating vertebral and posterior cerebral arteries when posterior circulation symptoms are present, according to the Journal of Neurointerventional Surgery 2, 3

Common Pitfall to Avoid

• The American Heart Association advises not to confuse atherosclerotic intracranial stenosis with cardioembolic stroke mechanisms, and to treat PCA stenosis as an atherosclerotic process requiring antiplatelet therapy and risk factor modification 1, 2, 3