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

Abstract

<jats:p> 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. </jats:p><jats:p> 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. </jats:p><jats:p> 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. </jats:p><jats:p> 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. </jats:p>

Long-Term Clinical and Imaging Follow-Up of Complex Intracranial Aneurysms Treated by Endovascular Parent Vessel Occlusion

“…47 In our study, only 3 patients with giant PCA aneurysms were treated by endovascular PVO. Consistent with the results of others, [47][48][49] the procedure proved to be generally safe and effective at treating these challenging aneurysms. We failed to completely obliterate a giant PCA aneurysm in a single patient who underwent a complex treatment course involving multiple endovascular and surgical procedures, with significant reduction in the size of the aneurysm and radiographic stability over a prolonged follow-up period of 6.7 years.…”

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

“…According to existing reports of endovascular treatment for P 2 segmental and distal aneurysms, most authors make the conclusion that PAO is a safe and effective therapy. 3,4,6,8,9,[12][13][14]18,21,24 pitfall of the pao Regardless of the surgical option, it seems that the parent artery cannot be preserved in most cases. Some authors have advocated an end-to-end anastomosis of the parent artery or bypass to avoid insufficient perfusion of the distal area.…”

“…However, excluding aneurysm from normal circulation can be accomplished easily by means of neurointervention without disturbing the surrounding tissue and perforating arteries; according to published literature, this is a safe and effective technique. 3,4,6,8,9,[12][13][14]18,21,24 With the continuing development of neurointervention, there is a trend to manage PCA aneurysms endovascularly. Despite the shape of the aneurysms, the pathological features of most P 2 segmental and distal aneurysms are considered to be dissecting.…”

“…2,22 However, in most intervention case series or reports, occluding the proximal PCA did not result in a poor clinical outcome, neither transiently nor permanently. We reviewed the literature related to P 2 segment and distal aneurysms since 2001 and collected information about these cases 3,4,6,8,9,[12][13][14]18,21,24 (Table 2). In these reports, there were 98 patients with P 2 and distal segmental aneurysms, and 76 aneurysms were treated by PAO.…”

“…3,4,6,8,9,[12][13][14]18,21,24 However, in our clinical practice, there are still severe neurological complications in patients who are treated interventionally and have a good preoperative status. In this study, we retrospectively reviewed the neurointerventional cases of P 2 segment and distal PCA aneurysms to evaluate the safety and efficacy of the technique and to analyze the risk factors that lead to poor outcome in these patients.…”