In the Pentarchy formulated by Justinian I (527–565), the emperor assigned as a patriarchate to the bishop of Rome the whole of Christianized Europe (including almost all of modern Greece), except for the region of Thrace, the areas near Constantinople, and along the coast of the Black Sea.
Justinian's system was given formal ecclesiastical recognition by the Quinisext Council of 692, which the see of Rome has, however, not recognized.
There were at the time bishops of other apostolic sees that operated with patriarchal authority beyond the borders of the Roman Empire, such as the catholicos of Selucia-Ctesephon.
Today, the patriarchal heads of Catholic autonomous churches are:[13] Four more of the Eastern Catholic Churches are headed by a prelate known as a "Major Archbishop,"[15] a title essentially equivalent to that of Patriarch and originally created by Pope Paul VI in 1963 for Josyf Slipyj.
They take precedence after the heads of autonomous churches in full communion, whether pope, patriarch, or major archbishop.
On 22 March 2006, the Pontifical Council for Promoting Christian Unity offered an explanation for the decision to remove the title.
The term patriarch has also been used for the leader of the extinct Manichaean religion, initially based at Ctesiphon (near modern-day Baghdad) and later at Samarkand.