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

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.

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

2017 ◽  
Vol 126 (4) ◽  
pp. 1094-1105 ◽  
Author(s):  
Xuanfeng Qin ◽  
Feng Xu ◽  
Yashengjiang Maimaiti ◽  
Yongtao Zheng ◽  
Bin Xu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Parent Artery Occlusion

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.

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

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.

Endovascular parent artery occlusion in large-giant or fusiform distal posterior cerebral artery aneurysms

2002 ◽  
Vol 44 (8) ◽  
pp. 700-705 ◽  
Author(s):  
Anil Arat ◽  
Civan Islak ◽  
Isil Saatci ◽  
Naci Kocer ◽  
Saruhan Cekirge
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion

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

2015 ◽  
Vol 123 (4) ◽  
pp. 906-914 ◽  
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.

Giant Multilocular Fusiform Aneurysm of the Posterior Cerebral Artery

1997 ◽  
Vol 3 (4) ◽  
pp. 319-324 ◽  
Author(s):  
H. Kon ◽  
M. Ezura ◽  
A. Takahashi ◽  
T. Yoshimoto
Keyword(s):  
Visual Field ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Photon Emission ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Emission Computed Tomography ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Matas Test

A 60-year-old woman presented with a giant posterior cerebral artery aneurysm. Her visual field examination revealed right upper quadrantanopia. Because of the difficulty of the neck clipping, we performed parent artery occlusion using the Guglielmi detachable coils following balloon Matas test monitored with single photon emission computed tomography (SPECT) with 99mTc-d, l hexamethyl-propylene-amine oxime. Postoperative left internal angiography showed the left occipital region was supplied by a leptomenigeal collateral via left the middle cerebral artery. Six months after embolisation the aneurysm was completely thrombosed on MR imaging. Her visual field deficits had also improved six months after embolisation. A combination of the balloon Matas test with SPECT followed by parent artery occlusion is an excellent method to treat such giant aneurysms.

scholarly journals Parent Artery Occlusion for Posterior Cerebral Artery Aneurysms

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 125-128 ◽  
Author(s):  
K. Hoya ◽  
M. Nagaishi ◽  
Y. Yoshimoto ◽  
E. Morikawa ◽  
H. Takahashi
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Balloon Test Occlusion ◽  
Parent Artery Occlusion ◽  
Permanent Occlusion

We review four cases of posterior cerebral artery (PCA) aneurysm, of which three showed intolerance of parent artery occlusion. In two, balloon test occlusion (BTO) indicated poor opacification of the PCA branches from the anastomoses, and therefore, permanent occlusion was not attempted.

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