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

Oishi, Hidenori; Tanoue, Shunsuke; Teranishi, Kosuke; Hasegawa, Hiroshi; Nonaka, Senshu; Magami, Shunsuke; Yamamoto, Munetaka; Arai, Hajime

doi:10.1136/neurintsurg-2015-011762

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…distal access catheter (DAC) was useful to identify perforating arteries arising from the PCA. 21) It may have been possible to identify the perforating branch through selective injection from DAC prior to PAO. If the perforating branch had been identified, this would have enabled a closer evaluation of the detailed anatomy of PCA where the coil should be placed during PAO.…”

Section: Discussionmentioning

confidence: 99%

A Recurrent Large Posterior Cerebral Artery Aneurysm Successfully Treated with Parent Artery Occlusion Using Somatosensory-Evoked Potential: A Case Report

Kugai

Suyama

Kitano

et al. 2022

JNET

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Objective: Treatment of large posterior cerebral artery (PCA) aneurysm involving the P1-P2 segment is difficult by both neurosurgery and endovascular treatment. Balloon occlusion test (BOT) to identify precise peripheral collateral flow is difficult prior to parent artery occlusion (PAO). Besides, PAO at the aneurysm at this location can cause peripheral cortical infarction of the occipital and temporal lobes and/or perforator infarction involving the midbrain and thalamus perfused by the perforating artery arising from the P1-P2 segment. However, detection of the perforator during PAO is difficult. Case Presentation:The patient was a 49-year-old woman. At the age of 43 years, a right large PCA aneurysm was discovered in the right P1-P2 segment. A simple technique coiling was performed. As recurrence was identified 1 year later, embolization was performed using a same procedure. Since further recurrences were later found, a third round of treatment was planned. Somatosensory-evoked potential (SEP) was recorded as intraoperative electrophysiological monitoring. Tortuosity of the right PCA was observed at the aneurysm neck and the distal right PCA could not be secured.We could neither perform stent-assisted coil embolization nor BOT in the right PCA. Hence, we inflated the balloon in the basilar artery and checked the collateral circulation routes retrograde into the right PCA from the right middle cerebral artery via a leptomeningeal anastomosis. PAO was performed on the right P1-P2 segment at the aneurysm neck.The signal of the SEP was not decreased, and the aneurysm was not visualized. Another coil was added to strengthen the PAO to the right P1 segment, which decreased the SEP amplitude in the extremities by 3 minutes after. As the last coil was thought to be occluding the perforator branching from the right P1 segment, it was removed without detaching.The SEP amplitude began to improve and recovered by 9 minutes after. There was no postoperative deficit. No recurrence of aneurysm was observed on MRA 9 months postoperatively. Conclusion:During PAO at the P1 segment of large PCA aneurysm involving the P1-P2 segment, SEP may be helpful to prevent perforator infarction, even if perforating artery originating from the proximal portion of the aneurysm was not detected by angiography.

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Section: Discussionmentioning

confidence: 99%

A Recurrent Large Posterior Cerebral Artery Aneurysm Successfully Treated with Parent Artery Occlusion Using Somatosensory-Evoked Potential: A Case Report

Kugai

Suyama

Kitano

et al. 2022

JNET

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“…However, PAO of the P1 segment should be avoided because the collateral circulation of the perforators that supply the brainstem and thalamoperforating artery are absent, and PAO will result in a serious infarct (39,52). When PAO is the last resort, preservation of the perorating artery is mandatory, and superselective injection is useful for identifying perforating arteries arising from the proximal PCA (83).…”

Section: Parent Artery Occlusionmentioning

confidence: 99%

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

Hou

2022

Front. Neurol.

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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.

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“…Aneurysms of the posterior cerebral artery (PCA) represent $ 1% of all intracranial aneurysms. [1][2][3][4] The surgical approach and dissection of the PCA is technically challenging due to the complexity of its perforating branches and their intimate relationship with the cranial nerves and with the upper brain stem. 5,6 A precise knowledge of the segmental anatomy of the PCA and its branches is essential when the surgical or endovascular approach to an aneurysm is planned, particularly if parent vessel occlusion is contemplated as a temporary control.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

et al. 2018

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Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

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

Cited by 5 publications

References 23 publications

A Recurrent Large Posterior Cerebral Artery Aneurysm Successfully Treated with Parent Artery Occlusion Using Somatosensory-Evoked Potential: A Case Report

A Recurrent Large Posterior Cerebral Artery Aneurysm Successfully Treated with Parent Artery Occlusion Using Somatosensory-Evoked Potential: A Case Report

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

Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

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