Introduction: Artery of Percheron (AOP) is a neurovascular variant, where the medial thalamic perforator supply to both thalami arise from a single unilateral vessel from the P1 segment (1). AOP occlusion can cause altered mental status, cognitive impairment and vertical gaze palsy (2). The diagnosis is challenging, and retrospective reviews show only 7% of patients receive hyperacute therapy. Majority of patients (82%) have a significant disability at three months following stroke (3).
Methods: We present a case of AOP occlusion from our institution diagnosed with advanced imaging techniques and treated with hyperacute therapy.
Results: A 68-year-old male presented with a 2 hour history of fluctuating level of consciousness. On examination, he required verbal stimulation to rouse, had dysarthric speech, and left sided ptosis. The presenting National Institutes of Health Stroke Scale (NIHSS) was 2. CT brain with angiogram revealed a non-occlusive defect in the P1 segment of the left posterior cerebral artery, and perfusion maps indicated bilateral medial thalamic ischaemia suspicious for an AOP occlusion.
The patient’s level of conscious subsequently deteriorated. He was given intravenous thrombolysis and referred for endovascular thrombectomy. Following treatment with a stent retriever, the P1 lesion was retrieved, achieving recanalization into the AOP. He made a complete recovery with no residual neurological deficit.
Conclusion: CT perfusion may aid in the diagnosis of AOP infarction. Hyperacute treatment including endovascular thrombectomy could be considered in cases where the AOP origin is occluded due to a lesion in the P1 segment.