Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

OBJECTIVE Aneurysms of the posterior cerebral artery (PCA) are uncommon. To date, a limited number of studies have examined the outcomes of endovascular treatment for PCA aneurysms. The authors' aim in this study is to report their experience with the endovascular treatment of PCA aneurysms. METHODS Between January 2007 and December 2014, 55 patients with 59 PCA aneurysms were treated using the endovascular approach at the authors' institution. Twenty-three patients had 25 saccular aneurysms, and 32 patients had 34 fusiform/dissecting aneurysms. The endovascular modalities included the following: 1) selective occlusion of the aneurysm (n = 22); 2) complete occlusion of the aneurysm and the parent artery (n = 20); 3) parent artery occlusion (n = 6); 4) partial coiling of the aneurysm and the parent artery (n = 5); and 5) occlusion of the dissecting aneurysm sac (n = 2). RESULTS The immediate angiographic results included 45 complete occlusions (82%), 2 nearly complete occlusions (4%), and 8 incomplete occlusions (14%). The mean follow-up period of 21.8 months in 46 patients showed 37 stable results, 6 further thromboses, and 3 recurrences. The final results included 41 complete occlusions (89%), 2 nearly complete occlusions (4%), and 3 incomplete occlusions (7%). Procedure-related complications included the following: 1) rebleeding (n = 1); 2) infarction (n = 4); and 3) perforation (n = 1). There was 1 (1.8%) procedure-related death due to rebleeding, and 2 (3.6%) non–procedure-related deaths due to severe subarachnoid hemorrhage. Clinical outcomes were excellent (Glasgow Outcome Scale 5) in 47 of 49 patients at the long-term follow-up. CONCLUSIONS PCA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiological outcomes. However, patients who present with severe SAH still have an overall poor prognosis. Partial coiling of the aneurysm and the parent artery is an attractive alternative treatment for patients who may not tolerate parent artery occlusion. Further study with a larger case series is necessary for validation of the durability and efficacy of this treatment.

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Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

Frontiers in Neurology ◽

10.3389/fneur.2021.746525 ◽

2022 ◽

Vol 12 ◽

Author(s):

Kun Huo ◽

Xianli Lv ◽

Jinlu Yu

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Good Prognosis ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

The Status ◽

Prime Objective

The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting. Sometimes, the PCA trunk can give rise to flow-related aneurysms in association with high-flow arteriovenous shunt diseases or moyamoya disease and internal carotid artery occlusion. Some PCA trunk aneurysms require treatment, especially ruptured or large/giant aneurysms. Recently, endovascular treatment (EVT) has become the mainstream treatment for PCA trunk aneurysms, and it mainly involves reconstructive or deconstructive techniques. Traditional EVT includes selective coiling with/without stent or balloon assistance and parent artery occlusion (PAO). For proximal aneurysms, the PCA should be preserved. For distal aneurysms, PAO can be performed. However, during EVT, preservation of the PCA must naturally be the prime objective. Recently, flow-diverting stents have been used and are a revolutionary treatment for unruptured dissecting aneurysms of the PCA trunk. Despite the associated complications, EVT remains an effective method for treating PCA trunk aneurysms and can result in a good prognosis.

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Fetal-type posterior cerebral artery: the pitfall of parent artery occlusion for ruptured P2 segment and distal aneurysms

Journal of Neurosurgery ◽

10.3171/2014.9.jns1442 ◽

2015 ◽

Vol 123 (4) ◽

pp. 906-914 ◽

Cited By ~ 8

Author(s):

Jing Xu ◽

Liang Xu ◽

Ziheng Wu ◽

Xianyi Chen ◽

Jun Yu ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Occlusion ◽

Neurological Deficits ◽

Parent Artery ◽

Adult Type ◽

Endovascular Occlusion ◽

Parent Artery Occlusion ◽

Ruptured Intracranial Aneurysm

OBJECT P2 segment and distal aneurysms are rare lesions of the cerebrovascular system. The efficacy and safety of endovascular occlusion for these types of aneurysms remain controversial. The aim of this study was to reveal risk factors for endovascular parent artery occlusion of ruptured P2 segment and distal aneurysms. METHODS Between March 2010 and November 2012, 812 patients with a ruptured intracranial aneurysm were admitted to the authors' hospital. Among them, 11 patients presented with P2 segment and distal posterior cerebral artery (PCA) aneurysms. These patients were subjected to endovascular treatment. Periprocedural data and clinical and angiographic records were studied retrospectively. RESULTS Of the patients with a ruptured PCA aneurysm, 2 of them underwent selective aneurismal coiling, and the remaining patients were treated with simultaneous occlusion of the parent artery. Patients with an adult-type PCA (n = 6), treated with either selective coiling or simultaneous parent artery occlusion, had no serious neurological deficits on follow-up. Four patients with a fetal-type PCA that was also occluded intraoperatively exhibited newly developed permanent paralysis and hemianopsia. However, 1 patient with a fetal-type PCA aneurysm that was selectively coiled recovered without complications. No recanalization was observed in any of the treated aneurysms. CONCLUSIONS Endovascular occlusion of an aneurysm and its parent artery is a safe and effective method for managing adult-type P2 segment and distal aneurysms. However, the authors' clinical data suggest that this method is of high risk for patients with fetal-type PCA aneurysms.

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Deliberate Parent Artery Occlusion for Non-Saccular Posterior Cerebral Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991101700204 ◽

2011 ◽

Vol 17 (2) ◽

pp. 159-168 ◽

Cited By ~ 13

Author(s):

L. Liu ◽

H. He ◽

C. Jiang ◽

X. Lv ◽

Y. Li ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Case Series ◽

Distal Segment ◽

Artery Occlusion ◽

Vascular Lesions ◽

Parent Artery ◽

Parent Vessel ◽

Parent Artery Occlusion ◽

Saccular Aneurysms

Posterior cerebral aneurysms are rare vascular lesions and usually present as non-saccular or dissecting in nature. We present a retrospective review of our experience in the deliberate parent artery occlusion of posterior cerebral artery (PCA) aneurysms. From June 2006 to June 2010, 12 patients (seven men, five women) with posterior cerebral artery non-saccular aneurysms presented to our department and were treated by parent artery occlusion. There were eight (66.7%) aneurysms located at the P2 segment, two (16.7%) at the P2–3 junction, one (8.3%) at the P1–2 junction and one (8.3%) at the P3 segment. Ten of the 12 patients were treated by aneurysm together with parent artery occlusion and two were treated by proximal occlusion. The procedure was technically successful in all cases. Angiography was performed immediately after the procedure in all patients and showed occlusion of the parent vessel with no filling of the aneurysm. Only one patient (8.3%) developed procedure-related transient hemianopsia and recovered within one month. The other 11 patients showed no additional neurological symptoms after procedure. Deliberate parent artery occlusion by detachable coils appears to be well tolerated for P2 or distal segment of PCA in our limited case series. We propose that this technique could be a good treatment option in treating non-saccular aneurysms in this location.

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Dissecting Aneurysm at the Proximal Anterior Cerebral Artery Treated by Parent Artery Occlusion

Interventional Neuroradiology ◽

10.1177/159101990901500121 ◽

2009 ◽

Vol 15 (1) ◽

pp. 123-126 ◽

Cited By ~ 11

Author(s):

M. Lv ◽

X. Lv ◽

Y. Li ◽

C. Jiang ◽

P. Jiang ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Proximal Anterior Cerebral Artery ◽

Neuroform Stent

Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare. We described the first documented endovascular treatment of an A1 portion dissecting aneurysm by parent artery occlusion. A 43-year-old man patient presented with subarachnoid hemorrhage. Cerebral angiography demonstrated a dissecting aneurysm of the left anterior cerebral artery (ACA) at A1 portion. Because of the dissecting nature of the A1 portion aneurysm, a 2.5×15-mm Neuroform stent was placed in the left A1 portion. However, regrowth of the aneurysm was found on the three month follow-up angiogram, so the aneurysm and the left A1 portion of ACA were occluded completely.

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Treatment of Intracranial Aneurysm with Bare Stent Only

Interventional Neuroradiology ◽

10.1177/15910199080140s213 ◽

2008 ◽

Vol 14 (2_suppl) ◽

pp. 75-78 ◽

Cited By ~ 3

Author(s):

Michael Mu Huo Teng ◽

Chao-Bao Luo ◽

Feng-Chi Chang ◽

Harsan Harsan

Keyword(s):

Intracranial Aneurysm ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Fusiform Aneurysm ◽

Surgical Clipping ◽

Parent Artery Occlusion ◽

Typical Treatment ◽

Dissecting Aneurysms

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

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Cerebral revascularization for the management of complex intracranial aneurysms: a single-center experience

Journal of Neurosurgery ◽

10.3171/2018.4.jns172752 ◽

2019 ◽

Vol 131 (4) ◽

pp. 1297-1307 ◽

Cited By ~ 3

Author(s):

Eric S. Nussbaum ◽

Kevin M. Kallmes ◽

Jeffrey P. Lassig ◽

James K. Goddard ◽

Michael T. Madison ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Case Series ◽

Artery Occlusion ◽

High Flow ◽

Cerebral Revascularization ◽

Low Flow ◽

Parent Artery ◽

Team Approach ◽

Parent Artery Occlusion

OBJECTIVEBecause simple intracranial aneurysms (IAs) are increasingly treated endovascularly, neurovascular surgery has become focused on complex IAs that may require deconstructive aneurysm therapy with concomitant surgical bypass. The authors describe the decision-making process concerning cerebral revascularization and present outcomes that were achieved in a large case series of complex IAs managed with cerebral revascularization and parent artery occlusion.METHODSThe authors retrospectively reviewed the medical records, including neuroimaging studies, operative reports, and follow-up clinic notes, of all patients who were treated at the National Brain Aneurysm Center between July 1997 and June 2015 using cerebral revascularization as part of the management of an IA. They recorded the location, rupture status, and size of each IA, as well as neurological outcome using the modified Rankin Scale (mRS), aneurysm and bypass status at follow-up, and morbidity and mortality.RESULTSThe authors identified 126 patients who underwent revascularization surgery for 126 complex, atheromatous, calcified, or previously coiled aneurysms. Ninety-seven lesions (77.0%) were unruptured, and 99 (78.6%) were located in the anterior circulation. Aneurysm size was giant (≥ 25 mm) in 101 patients, large (10–24 mm) in 9, and small (≤ 9 mm) in 16 patients. Eighty-four low-flow bypasses were performed in 83 patients (65.9%). High-flow bypass was performed in 32 patients (25.4%). Eleven patients (8.7%) underwent in situ or intracranial-intracranial bypasses. Major morbidity (mRS score 4 or 5) occurred in 2 (2.4%) low-flow cases and 3 (9.1%) high-flow cases. Mortality occurred in 2 (2.4%) low-flow cases and 2 (6.1%) high-flow cases. At the 12-month follow-up, 83 (98.8%) low-flow and 30 (93.8%) high-flow bypasses were patent. Seventy-five patients (90.4%) undergoing low-flow and 28 (84.8%) high-flow bypasses had an mRS score ≤ 2. There were no statistically significant differences in patency rates or complications between low- and high-flow bypasses.CONCLUSIONSWhen treating challenging and complex IAs, incorporating revascularization strategies into the surgical repertoire may contribute to achieving favorable outcomes. In our series, low-flow bypass combined with isolated proximal or distal parent artery occlusion was associated with a low rate of ischemic complications while providing good long-term aneurysm control, potentially supporting its wider utilization in this setting. The authors suggest that consideration should be given to managing complex IAs at high-volume centers that offer a multidisciplinary team approach and the full spectrum of surgical and endovascular treatment options to optimize patient outcomes.

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Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2015.12.049 ◽

2016 ◽

Vol 32 ◽

pp. 41-46 ◽

Cited By ~ 2

Author(s):

Hideaki Matsumura ◽

Noriyuki Kato ◽

Yusuke Fujiwara ◽

Hisayuki Hosoo ◽

Tomosato Yamazaki ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Vascular Insufficiency

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Endovascular parent artery occlusion of proximal posterior cerebral artery aneurysms: a report of two cases

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011762 ◽

2015 ◽

Vol 8 (6) ◽

pp. 591-593

Author(s):

Hidenori Oishi ◽

Shunsuke Tanoue ◽

Kosuke Teranishi ◽

Hiroshi Hasegawa ◽

Senshu Nonaka ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Thalamic Infarction ◽

Perforating Arteries

We report two cases of proximal posterior cerebral artery (PCA) aneurysms treated with endovascular parent artery occlusion (PAO) with coils. In both cases, selective injection from the 4 F distal access catheter clearly showed the perforating arteries arising from the PCA. Case No 1, a 49-year-old woman, was successfully treated with preservation of a paramedian artery. Case No 2, a 54-year-old woman, was treated in the same manner. The patient underwent extensive thalamic infarction after the procedure because of paramedian artery occlusion. Endovascular PAO with coils is feasible for proximal PCA aneurysms; however, preservation of perforating arteries arising from the PCA is mandatory.

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