Dissecting Aneurysms of Posterior Cerebral Artery: Clinical Presentation, Angiographic Findings, Treatment, and Outcome

Abstract

Background: The dissecting posterior cerebral artery (PCA) aneurysms are very rare. These aneurysms pose significant treatment challenge and need careful evaluation to formulate an optimal treatment plan in case of ruptured or un-ruptured presentations. Methods: Retrospective review of a prospectively collected data. Results: Seven patients with dissecting aneurysms of the PCA were identified. Six out of seven presented with subarachnoid hemorrhage (SAH) and one with ischemic stroke. Three out of seven were treated with endovascular coil embolization without sacrifice of the parent artery and the rest had parent artery occlusion (PAO) with coil embolization. None of the patients developed new neurological deficits post-procedure. Aneurysm re-occurred in two patients that were treated without PAO. Conclusion: Endovascular treatment of the dissecting PCA aneurysm is safe and feasible. It can be performed with or without PAO. Recurrence is more common without PAO and close follow-up is warranted.

Optional Endovascular Therapy of Dissecting Posterior Cerebral Artery Aneurysm

“…Isolated PCA dissections tend to present with ischemic symptoms and have a more benign clinical course and prognosis [13]. Taqi et al [14] found that subarachnoid hemorrhage is present in approximately 86% of cases (6 of 7), and 14% (1 of 7) have ischemic stroke. In other study, 54% had subarachnoid hemorrhage, 25% focal neurological deficits without subarachnoid hemorrhage, and 21% were discovered accidentally [3,11], [15,16,17,18,19,20,21,22,23,24,25,26].…”

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

“…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.…”

“…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.…”

“…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.…”