Premammillary Artery Infarction after Microsurgical Clipping of Unruptured Posterior Communicating Artery Aneurysm: Risk Factors, Surgical, and Anatomical Considerations

Abstract Purpose Posterior communicating artery (PCoA) aneurysm is common and sometimes requires microsurgery; however, as data on premammillary artery (PMA) infarction after clipping is scarce, we retrospectively reviewed cases of post-clipping PMA infarction to analyze incidence, independent risk factors of infarction, and anatomical considerations. Methods Data from 569 consecutive patients who underwent microsurgical clipping for unruptured PCoA aneurysm between January 2008 and December 2020 were included. Patients were categorized into the normal or the PMA infarction group. Statistical analyses and comparisons between the two groups were used to determine the influence of various factors. Results The normal group included 515 patients while the PMA infarction group had 31. The mean length of hospital stay was significantly longer in the PMA infarction group (10.3 ± 9.1 days) than in the normal group (6.5 ± 6.4 days; p < 0.0001). The distribution of Glasgow Outcome Scale (GOS) at discharge was significantly different between the two groups (p ≤ 0.0001) but was not so at 6 months after discharge (p = 0.0568). Multivariate-logistic-regression analysis identified aneurysm size (odds ratio [OR], 1.194; 95% confidence interval [CI], 1.08–1.32; p = 0.0005) and medial direction of aneurysm (OR, 4.615; 95% CI, 1.224–17.406; p = 0.0239) as independent risk factors of post-clipping PMA infarction. Conclusions Surgeons must beware of PMA infarction after clipping of large aneurysms that are medial in direction. Intraoperative verification of the patency of the PCoA and the PMA from various angles using various intraoperative methods can reduce morbidity due to PMA infarction.

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Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm

Interventional Neuroradiology ◽

10.1177/1591019915583000 ◽

2015 ◽

Vol 21 (2) ◽

pp. 171-174 ◽

Cited By ~ 3

Author(s):

Takashi Mitsuhashi ◽

Nobuaki Takeda ◽

Hidenori Oishi ◽

Hajime Arai

Keyword(s):

Artery Aneurysm ◽

Good Alternative ◽

Artery Occlusion ◽

Posterior Communicating Artery ◽

Parent Artery ◽

Microsurgical Clipping ◽

Parent Artery Occlusion ◽

Endovascular Coil Embolization ◽

Posterior Communicating Artery Aneurysm

A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm.

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Zero-Delay Mechanical Thrombectomy for Distal Large Vessel Occlusion Detected on Intraoperative Angiogram After Microsurgical Clipping of a Posterior Communicating Artery Aneurysm: Value of Hybrid Operating Room

World Neurosurgery ◽

10.1016/j.wneu.2018.08.088 ◽

2018 ◽

Vol 119 ◽

pp. 278-281 ◽

Cited By ~ 1

Author(s):

Sanjay Konakondla ◽

Christoph J. Griessenauer ◽

Reginald P. Fong ◽

Oded Goren ◽

Clemens M. Schirmer

Keyword(s):

Operating Room ◽

Mechanical Thrombectomy ◽

Artery Aneurysm ◽

Posterior Communicating Artery ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Hybrid Operating Room ◽

Vessel Occlusion ◽

Microsurgical Clipping ◽

Posterior Communicating Artery Aneurysm

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Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery

Surgical Neurology International ◽

10.4103/2152-7806.158515 ◽

2015 ◽

Vol 6 (1) ◽

pp. 101 ◽

Cited By ~ 1

Author(s):

Hiroshi Kashimura ◽

Masaru Takeda ◽

Kohei Chida ◽

Toshiyuki Murakami

Keyword(s):

Artery Aneurysm ◽

Distal Portion ◽

Posterior Communicating Artery ◽

Microsurgical Clipping ◽

Posterior Communicating Artery Aneurysm

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Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms

Frontiers in Neurology ◽

10.3389/fneur.2021.653589 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jinlong Yuan ◽

Chenlei Huang ◽

Zhenbao Li ◽

Xiaochun Jiang ◽

Xintong Zhao ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Roc Analysis ◽

Multivariate Logistic Regression Analysis ◽

Posterior Communicating Artery ◽

Morphological Parameters ◽

Hemodynamic Parameters ◽

Multivariate Logistic Regression ◽

Independent Risk Factors ◽

Wall Shear

Objective: Morphological and hemodynamic parameters might predict rupture of intracranial aneurysms (IAs). A practical model for the study is patients with ruptured mirror IAs in which one is ruptured and the other is unruptured. Although there have been analyses of the morphology and hemodynamics of ruptured mirror posterior communicating artery aneurysms (PComAAs), the sample sizes in these studies were small and only considered hemodynamics or morphological characters. Therefore, this study aimed to investigate the morphological and hemodynamic parameters associated with ruptured mirror PComAAs.Methods: We considered 72 patients with ruptured mirror PComAAs using computational fluid dynamics (CFDs). Ruptured mirror PComAAs were divided into ruptured and unruptured groups. Fourteen morphological and eight hemodynamic parameters were calculated and compared. Significant parameters were analyzed by the multivariate logistic regression to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all independent risk factors to determine the predictability and identify the optimal threshold.Results: Four hemodynamic and three morphological parameters were significantly different between ruptured and unruptured groups: normalized wall shear stress (NWSS), mean WSS, low wall shear WSS area (LSA%), size, aspect ratio (AR), size ratio (SR), and inflow angle (IA). Multivariate logistic regression analysis showed that AR, SR, NWSS, mean WSS, and LSA% were all independent factors significantly associated with PComAAs rupture. The ROC analysis for independent risk factors indicated that AR (0.751), NWSS (0.755), mean WSS (0.69), and LSA (0.778) had merely acceptable AUC values. Only SR (0.803) had a high acceptable AUC value. The threshold value of SR was 1.96.Conclusions: SR (>1.96) was the most significant parameter associated with IA rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture.

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