Comparative analysis of coil embolization in posterior and anterior communicating artery aneurysms

Abstract

BackgroundRecanalization rates after coil embolization are known to be higher in cerebral aneurysms of the posterior (vs anterior) circulation. Although often grouped with anterior lesions, aneurysms of the posterior communicating artery (PcoA) may nevertheless behave differently.ObjectiveWe performed a comparative analysis to explore differences in recanalization rates of PcoA and anterior communicating artery (AcoA) aneurysms, both integral to the circle of Willis.MethodsBetween October 2012 and July 2017, 699 AcoA (n=427) and PcoA (n=272) aneurysms were treated by endovascular coil embolization, monitoring 667 (95.4%) via radiologic imaging for ≥ 6 months. Cumulative recordings of medical and imaging data were retrospectively reviewed, conducting propensity score matching and binary logistic regression analysis.ResultsIn the 667 aneurysms followed longer term, recanalization occurred in 111 (16.6%; minor 72; major 39) and was significantly more frequent in PcoA (25.5%) than in AcoA (11.0%; P<0.01) aneurysms during similar follow-up periods. After 1:1 propensity score matching, an even greater proclivity for recanalization was evident at PcoA sites (PcoA 23.0%; AcoA 12.2%; P<0.01). Although A1 segment dominance was linked to recanalization in AcoA aneurysms (18.2% vs 7.6%; P=0.01), the PcoA counterpart had no bearing on recanalization (27.7% vs 24.1%; P=0.51).ConclusionsDespite a clear preponderance of AcoA aneurysms, recanalization of PcoA aneurysms proved significantly greater, attesting to posterior circulation behavior.

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

“…The ISAT study has shown that PcoA aneurysms are subjected to recoiling procedures more often than aneurysms at other sites (p=0.03) 17. Another study aimed at differing rates of recanalization in aneurysms of the anterior communicating artery (AcoA) and PcoA has also confirmed more frequent recanalization in the latter, likely due to posterior circulatory behavior 8. There were similar results in our study.…”

“…The posterior communicating artery (PcoA) provides a crucial link between the anterior and posterior cerebral circulation and is particularly important clinically, accounting for approximately 25% of all intracranial aneurysms 7. Furthermore, there is evidence that recanalization after coil embolization is frequent in this location 1 8. The hemodynamic stress imposed on coiled aneurysms of the PcoA is clearly influenced by flow from the internal carotid artery (ICA), and anatomic variants of the PcoA may play a role as well.…”

The different recanalization rates of posterior communicating artery aneurysms with a fetal posterior communicating artery and anterior communicating artery aneurysms with a variation of the unilateral A1 segment

“…The incidence rates of fPCA and variation of the unilateral A1 segment in this study were 27.9% (41/147) and 64.2% (43/67), respectively, which are similar to those seen in other studies (30-40% and >60%) (3,6). Prior studies have suggested that PcomA aneurysms are more likely to recur than AcomA aneurysms (37.2% versus 25.0%, P=0.259, and 23.0% versus 12.2%, P<0.01) (2,12). However, these studies appeared to have neglected P1 or A1 segment variation factors that could increase these aneurysms' recanalization rates.…”

“…From January 2013 to January 2020, patients with either PcomA aneurysms or AcomA aneurysms at our center were included in this study. fPCA can be divided into 2 types: partial fPCA and full fPCA (8), and variation of the A1 segment can likewise be divided into 2 types: Al segment hypoplasia and unilateral absent A1 segment (2).…”

“…Posterior communicating artery (PcomA) aneurysms account for 15-20% of all intracranial aneurysms, while anterior communicating artery (AcomA) aneurysms occupy a close proportion, with approximately 20% (1). Although the similar incidence rate was assumed to be related to similar hemodynamics, the recanalization rate of PcomA aneurysms was almost twice that of AcomA aneurysms (23.0% vs. 12.2%) (2). Despite this, previous studies on the subject seem to have taken no account of vascular variations, altering hemodynamics and affecting aneurysm recanalization.…”