Endovascular therapy for posterior communicating artery-infundibular dilatation aneurysms

2021 ◽  
Vol 7 (6) ◽  
pp. 6511-6518
Author(s):  
Xinggen Fang ◽  
Degang Wu ◽  
Niansheng Lai ◽  
Jinlong Yuan ◽  
Zhenbao Li ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Posterior Communicating Artery ◽  
Vertebral Angiography ◽  
Ruptured Aneurysms ◽  
Aneurysm Embolization ◽  
Lost To Follow Up

Objective: The purpose of this study was to explore the effect of endovascular therapy on posterior communicating artery-infundibular dilatation aneurysms. Methods: A total of 15 patients with ruptured aneurysms caused by posterior communicating artery-infundibular dilatation who were treated in our neurosurgical center from January 2015 to December 2018were included in this study. They were performed with bilateral internal carotid angiography and vertebral angiography and treated with endovascular method. The modified Rankin Scale (mRS) was used for clinical follow-up for 18 months. Results: There were 10 patients in the posterior communicating artery-infundibular dilatation aneurysms with non-fetal posterior cerebral artery. Among them, 8 patients were treated with coil-alone embolization. Immediate imaging showed infundibular dilation residual in 6 cases and no contrast filling in either infundibular dilation or aneurysm in 2 case. Another 2 were treated with stent-assisted coiling embolization, and immediate imaging showed no contrast filling. Of the 5 patients in posterior communicating artery-infundibular dilatation aneurysms with fetal posterior cerebral artery, 4 were only coiled in the aneurysm sack with contrast filling in infundibular cones, and 2 were treated with stent assisted coiling. Among the 10 patients with non-fetal posterior cerebral artery, 3 showed recurrence, 4 showed stable images, 2 were also stable with no contrast filling in infundibular dilation or aneurysm and 1 was lost to follow-up. Among the 5 patients with fetal posterior cerebral artery, 1 showed stable images, 3 showed recurrence and 1 was lost to follow-up. Conclusions: For posterior communicating artery-infundibular dilatation aneurysms with non-fetal posterior cerebral artery, stent-assisted coiling of aneurysm embolization combined with occlusion of cones is effective to prevent or reduce recurrence.

Competitive flow diversion of multiple P1 aneurysms: proposed classification

2020 ◽  
Vol 13 (6) ◽  
pp. e015581
Author(s):  
Mark Alexander MacLean ◽  
Thien J Huynh ◽  
Matthias Helge Schmidt ◽  
Vitor M Pereira ◽  
Adrienne Weeks
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Flow Diversion ◽  
Endovascular Coiling ◽  
Ruptured Aneurysms ◽  
The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

Abstract 134: Endovascular Revascularization Is Associated With Better Outcomes Than Systemic Throbmolysis Alone For Tandem Internal Carotid And Middle Cerebral Artery Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Joshua Pepper ◽  
Rashmi Pashankar ◽  
Joseph Schindler ◽  
Ketan Bulsara
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Complication Rates ◽  
Modified Rankin Scale ◽  
Systemic Thrombolysis ◽  
Iatrogenic Complications ◽  
Significant Difference

Background and Purpose: Tandem Internal Carotid Artery and Middle Cerebral Artery or “TIM” occlusions are highly resistant to conventional therapy (systemic thrombolysis) and independently predicts poor patient outcome. Recent evidence suggests that patients treated more aggressively with either endovascular stenting of occluded carotid arteries and/or intra-arterial tissue plasminogen activator (tPA) may have superior outcomes. Here we evaluate all the available data to help assess the best intervention for this patient population that currently has limited treatment options. Methods: Data from Medline and the Cochrane database of systemic reviews was searched. The search terms used includes (tandem OR combined) AND (middle cerebral OR internal carotid) AND (OCCLU* or lesion or stenos* or blocka*). All studies had to be in English. All duplicates were identified and removed. To be included the studies needed to report on three key aspects: 1) baseline characteristics (age; NIHSS at presentation); 2) treatment (time to treatment; modality); and 3) outcome (report of patient state at discharge or follow up on the Modified Rankin Scale). Patients were grouped according to whether they received endovascular intervention or stand alone IV tPA. Patients were considered independent if they had a Modified Rankin Scale score of ≤ 2 at follow up or discharge. Results: Over 2,500 studies were evaluated. Seventeen studies met the inclusion criteria, with a total of 219 patients. Patients treated with endovascular therapy (n=60) (stenting and/or intra-arterial tPA) were 32% more likely to be independent (p<0.0001) and 28% less likely to have a significant disability (p= 0.0004) compared to patients given systemic thrombolysis (n=139). There was no significant difference in mortality or complication rates between the groups. Conclusion: Endovascular therapy appears to be superior compared with systemic thrombolysis in treating patients with TIM occlusions. The risk of iatrogenic complications with more aggressive intervention does not appear to outweigh the outcome benefit. Further and larger studies are needed to assess the benefits and risks of endovascular therapy in patients with TIM lesions.

Republished: Competitive flow diversion of multiple P1 aneurysms: proposed classification

2020 ◽  
Vol 12 (9) ◽  
pp. e7-e7
Author(s):  
Mark Alexander MacLean ◽  
Thien J Huynh ◽  
Matthias Helge Schmidt ◽  
Vitor M Pereira ◽  
Adrienne Weeks
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Flow Diversion ◽  
Endovascular Coiling ◽  
Ruptured Aneurysms ◽  
The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

scholarly journals Coiling of a recurrent broad-necked posterior communicating aneurysm incorporating a fetal cerebral artery: A technical case report

2015 ◽  
Vol 21 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Young-Joon Kim ◽  
Jung Ho Ko
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Contralateral Internal Carotid Artery

We describe a case of a right broad-necked posterior communicating artery (PcomA) aneurysm with a fetal posterior cerebral artery (PCA) incorporated in the aneurysm neck. We performed waffle cone stent-assisted coiling and achieved almost complete occlusion of the aneurysm. At 18-month follow-up angiography, the aneurysm was recanalized and further coiling was needed. The same waffle cone method of coiling might be expected to produce the same unsatisfactory results on follow-up, so we decided to use retrograde stent navigation and placement through the anterior communicating artery (AcomA) from the contralateral internal carotid artery (ICA) to the ipsilateral ICA and fetal PCA. The stent delivery microcatheter from the contralateral ICA could not be introduced in the AcomA. So 2 mg nimodipine was infused through the stent delivery microcatheter to the AcomA and the stent delivery microcatheter was passed through the AcomA easily and could be navigated to the ipsilateral A1, ICA, and to the fetal PCA. With this additional stent, the aneurysm was completely separated from the fetal PCA and ICA. Further coiling could be performed safely through the microcatheter in the ipsilateral ICA. The patient had stable aneurysm occlusion at the six-month follow up.

scholarly journals Endovascular treatment of posterior communicating artery aneurysms in the presence of the fetal variant of posterior cerebral artery

2015 ◽  
Vol 21 (4) ◽  
pp. 456-461 ◽  
Author(s):  
Zhi Chen ◽  
Yin Niu ◽  
Jun Tang ◽  
Lin Li ◽  
Zhou Feng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Clinical Evidence ◽  
Posterior Cerebral Artery ◽  
Therapeutic Strategies ◽  
Posterior Communicating Artery ◽  
Hemorrhagic Complication ◽  
Multiple Strategies ◽  
Angiographic Findings

Posterior communicating artery (PcomA) aneurysms in the presence of the fetal variant of posterior cerebral artery (PCA) often pose technical challenges for endovascular treatment because of a greater potential for ischemic injury with the fetal PCA compromise. The purpose of this study was to assess the feasibility and results of endovascular treatment for these lesions. We retrospectively reviewed our experience and results of endovascular treatments for a series of nine consecutive patients with PcomA aneurysms occurring at the origin of fetal PCAs at the Department of Neurosurgery of Southwest Hospital, Chongqing, China, between June 2011 and June 2014. Depending on the angiographic findings, location and shape of the aneurysms, various therapeutic strategies were used including coiling by single or double microcatheter, balloon remodeling technique, and single or Y-stenting technique. Overall, fetal PCA was preserved patent in all cases, and complete or near complete occlusion was achieved in 8/9 cases. There was no procedure-related morbidity or mortality. With the exception of one patient who died of pneumonia 6 weeks after treatment, no clinical evidence of neurologic deterioration and hemorrhagic complication was seen during the follow-up period in the remaining 8 patients. Our experience suggests that endovascular treatment is relatively safe and technically feasible in most patients with PcomA aneurysms in the presence of fetal PCA using multiple strategies.

Percutaneous Transluminal Angioplasty for Intracranial Atherosclerotic Stenosis

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 53-56 ◽  
Author(s):  
S. Mandai ◽  
H. Matsushita ◽  
S. Akamatsu ◽  
Y. Maeda ◽  
Y. Gohda ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Transluminal Angioplasty ◽  
Atherosclerotic Stenosis ◽  
Permanent Neurological Deficit ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Eleven patients with symptomatic intracranial atherosclerotic stenotic lesions underwent percutaneous transluminal angioplasty (PTA). Seven patients had stenosis in M1 segment of the middle cerebral artery (MCA), two in the cavernous internal carotid artery, one in M2 segment of the MCA and one in the P2 segment of the posterior cerebral artery. Initial successful dilatation (less than 50% residual stenosis) was obtained in nine patients (81.8%). Permanent neurological deficit related to PTA was seen in one patient and transient symptoms were observed in two. Re-stenosis was revealed in two cases (18.2%) in the early follow-up period. All patients with successful dilatation and without re-stenosis never had TIA or stroke after PTA. Intracranial PTA is an effective procedure, but several problems remain to be solved.

scholarly journals Horizontal Stenting via Retrograde Route for Recurrent Ruptured Posterior Communicating Artery Aneurysm after Clipping: A Case Report and Literature Review

2021 ◽  
Author(s):  
Michiyasu Fuga ◽  
Toshihide Tanaka ◽  
Rintaro Tachi ◽  
Ryo Nogami ◽  
Akihiko Teshigawara ◽  
...  
Keyword(s):  
Case Report ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Coil Embolisation ◽  
Ruptured Aneurysms ◽  
Branch Vessel ◽  
Posterior Communicating Artery Aneurysm ◽  
Contralateral Internal Carotid Artery

Treatment of recurrent ruptured aneurysms incorporating a branch vessel arising from the dome is challenging. Here, we attempted horizontal stent-assisted coil embolisation via a retrograde route from the contralateral internal carotid artery to treat a small ruptured posterior communicating artery aneurysm incorporating a foetal variant posterior cerebral artery after clipping.

scholarly journals Treatment Strategy for Aneurysms of the Posterior Cerebral Artery

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 83-88 ◽  
Author(s):  
O. Suzuki ◽  
S. Miyachi ◽  
M. Negoro ◽  
T. Okamoto ◽  
Y. Sahara ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Artery ◽  
Conservative Therapy ◽  
Posterior Cerebral Artery ◽  
Mass Effect ◽  
The Other ◽  
Spontaneous Thrombosis ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms

The authors carried out a retrospective review of the records of 12 patients with aneurysms of the posterior cerebral artery (PCA). Four were asymptomatic, 1 presented with a mass effect, and 7 with a subarachnoid haemorrhage (SAH). Of the 7 ruptured aneurysms, 3 were embolized and 2 were clipped. However, 2 patients died from rebleeding before any treatment. Of the 5 unruptured aneurysms, 1 was embolized with coils but the remaining 4 have been conservatively observed. No aneurysms have ruptured during the follow-up period, and 3 have thrombosed spontaneously. According to our results, the PCA aneurysms should be treated aggressively in the early phase. Although the preservation of the anatomical integrity of the PCA should naturally be one of the prime objectives, PCA occlusion may sometimes be inevitable when treating large or fusiform aneurysms. On the other hand, conservative therapy is one of the options for the treatment of incidentally encountered unruptured ones, because these have the possibility of spontaneous thrombosis.

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