Endovascular treatments for distal posterior cerebral artery aneurysms

Abstract

AIm:The purpose of the current study was to evaluate the methods and results of endovascular treatments for distal posterior cerebral artery (PCA) aneurysms. mAterIAl and methOds:We studied 10 patients admitted to our hospital, of which 6 had aneurysms at the P2 segment (2 were saccular, 2 were fusiform, 2 were dissecting), 1 had a dissecting aneurysm at the P2-P3 junction and 3 had dissecting aneurysms at the P3 segment. Coil embolization was used for saccular aneurysms to retain parent arteries, stent was used for fusiform aneurysm to reconstruct the parent arteries, coil embolization in combination with parent artery occlusion was used for dissecting aneurysms at P2 segment or P2-P3 junction, aneurysm embolization in combination with parent artery occlusion by Glubran glue was used for dissenting aneurysms at the P3 segment.results: Nine patients got a score of 5, one patient got a score of 4. DSA follow up in nine accepted the review (one patient with fusiform aneurysm at the P2 segment was lost). No reoccurrence was found. COnClusIOn:The results of this study suggested that to achieve a satisfying prognosis, the types and locations of the aneurysms should be considered when performing the endovascular treatment for distal PCA aneurysms. yÖntem ve GereÇler: Posterior serebral arter anevrizması olan 10 hasta çalışmaya alındı. Anevrizmalardan 6'sı P2 bölümündeydi (Bunların 2'si sakküler, 2'si fusiform, 2'si disekan anevrizma şeklindeydi). Biri P2-P3 bileşkesinde disekan bir anevrizma, son 3'ü ise P3 bölümünde ve 3'üde disekan anevrizma şeklindeydi. Kese şeklinde olan anevrizmalarda ana arter korunarak koil embolizasyonu, fusiform anevrizmalarda ana arter korunarak ana artere stent yerleştirilip ana arter rekonstrüksiyonu sağlandı. P2 bölümündeki veya P2-P3 birleşim noktasındaki disekan anevrizmalarda koil embolizasyonu ile parent arterin oklüzyonu sağlanmıştır. P3 bölümünden kaynaklanan disekan anevrizmalarda Glubran Zamkı ile tıkanma sağlanmıştır.BulGulAr: Hastaların 9'unda 5 skoru sağlandı, bir hastada ise 4 skoru sağlandı. Hastaların 9'una konrol anjiyografisi yapıldı. Rekürrens saptanmadı. P2 segmentinde fusiform anevrizması olan bir hasta kaybedildi. sOnuÇ: Distal posterior serebral arter anevrizması olan hastalarda anevrizmanın tipi ve yerleşimi göz önüne alındığında endovasküler tedavi tatmin edici ve başarılı bir prognoz sağlamaktadır.

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.…”

40 Posterior Cerebral Artery Aneurysms

“…[1][2][3] Because of this low incidence, most of the institutional series on PCA aneurysms are small 2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] ; only 7 reports with more than 25 patients have previously been published ( Table 1). 1,[18][19][20][21][22][23] The largest series was reported by Drake et al 7 in a study of 125 cases.…”