Dissecting Aneurysms of the Posterior Cerebral Artery

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>BACKGROUND:</jats:title><jats:p>Posterior cerebral artery (PCA) aneurysms are relatively rare, making up 1% to 2% of all intracranial aneurysms. To date, most clinical series are heterogeneous in nature, with few reports of isolated PCA dissecting aneurysms. Their clinical presentation can vary greatly, and the potential for long-term sequelae during or after treatment remains relatively high.</jats:p></jats:sec><jats:sec><jats:title>OBJECTIVE:</jats:title><jats:p>To report our recent experience in 9 consecutive patients with PCA dissecting aneurysms with a discussion of the unique clinical challenges of their evaluation and treatment.</jats:p></jats:sec><jats:sec><jats:title>METHODS:</jats:title><jats:p>We conducted a retrospective review of 9 consecutive patients with PCA dissecting aneurysms from November 2003 to February 2010. Their hospital charts and follow-up records were reviewed and summarized.</jats:p></jats:sec><jats:sec><jats:title>RESULTS:</jats:title><jats:p>We identified 6 male and 3 female patients ranging in age from 7 months to 69 years (median age, 53 years). None had any associated trauma. Four patients presented with subarachnoid hemorrhage. Three presented with intraventricular and intracerebral hemorrhage. The remaining 2 presented with headache and acute onset of right-sided numbness, respectively. Four underwent endovascular embolization; 2 underwent surgical clipping; and the remaining 3 were managed medically and followed up conservatively. The dissecting aneurysms involved P1 (n = 2), P1-2 junction (n = 1), P2 (n = 4), and P2-3 junction (n = 1). At a mean follow-up of 3 months, 6 patients had excellent functional outcome with modified Rankin Scale score of 0 or 1. The remaining 3 patients who presented in deep coma did poorly (1 died and 2 had severe disabilities).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION:</jats:title><jats:p>PCA dissecting aneurysms pose a unique challenge and have many unresolved issues regarding treatment modalities.</jats:p></jats:sec>

Parent Artery Occlusion for a Dissecting Posterior Cerebral Artery Aneurysm in the P4 Segment Presenting with Ischemic Stroke and Rapid Growth: A Case Report

“…Trauma or stress on the arterial wall of the PCA along the tentorial edge may have developed dissecting PCA aneurysms. 5 , 6 )…”

“…In their case series, 60% of the patients who underwent PAO without BTO developed PCA territory infarctions, whereas 20% of the patients who received PAO after passing the BTO experienced PCA territory infarctions. 6 ) For unruptured dissecting aneurysms, conservative management is acceptable 5 , 7 , 8 ) since most dissections heal spontaneously within 3-6 months with medical treatment, and dissecting aneurysms are usually stable. 14 ) Conversely, large or growing aneurysms are typically treated.…”

“…The optimal timing for intervention remains unclear, but careful observation is crucial, considering the past reports of dissecting aneurysms exhibiting growth over several months to even a year. 3 , 5 , 6 , 12 , 15 )…”

“…Both dissections may result in aneurysms of various shapes. 5 , 6 ) Treatment of dissecting PCA aneurysms is challenging because of the severe ischemic complication risks for posterior circulations. For ruptured cases, surgical or endovascular intervention is necessary to prevent rebleeding.…”

Dissecting intracranial aneurysm in pregnancy: A rare association

“…The options include surgery, endovascular techniques, and conservative management. [202122] Ischemia can be countered by augmenting blood volume and blood pressure, which might increase perfusion to the ischemic area through collateral vessels. However, if thrombus formation is the main underlying component, anticoagulation (heparin/warfarin) could theoretically prevent thrombus formation and embolization.…”