Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion

Matsumura, Hideaki; Kato, Noriyuki; Fujiwara, Yusuke; Hosoo, Hisayuki; Yamazaki, Takahisa; Yasuda, Susumu; Matsumura, Akira

doi:10.1016/j.jocn.2015.12.049

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…In this study, we described clinical data of 74 aneurysms in the origin site of posterior cerebral artery firstly (Table 1). We noticed some common features as aneurysms of other types, such as a female preponderance (56 vs 18) [21,22], high prevalence of hypertension (62.2%) [23], and high rupture rate, which are in accordance with the previous reports.…”

Section: Discussionsupporting

confidence: 91%

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Chen

Wang

et al. 2020

Chin Neurosurg Jl

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Background: The aim of this study was to retrospectively analyze our experience with the patients who underwent surgical treatment of posterior communicating artery (PComA) aneurysms originating from fetal posterior cerebral artery (fPCA) and analyze the risk factors for the postoperative radiological infarction and outcome. Methods: From 2011 to 2020, we retrospectively reviewed 74 PComA aneurysms originating from fPCA in terms of the clinical and radiological features and obtained the follow-up data from the

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Section: Discussionsupporting

confidence: 91%

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Chen

Wang

et al. 2020

Chin Neurosurg Jl

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“…Apart from this, there was no statistically significant difference between PCA aneurysms and the other aneurysms in terms of morphology, treatment strategy, antithrombotic therapy, and immediate occlusion status. Previously, Matsumura et al 19) reported a similar rate of ischemic complications with PAO for ruptured and unruptured PCA aneurysms (2/5 cases; 40%). Xu et al 20) also reported an extremely high rate of ischemic complications with ruptured PCA aneurysms (8/8; 100%).…”

Section: Discussionmentioning

confidence: 71%

Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3

Nishi

Ishii

Satow

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02–5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07–221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.

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“…Eighteen patients who underwent treatment for aneurysms of fetal-type PCAs have been reported previously. Of these 18 patients, cerebral infarction occurred in 11 of the 15 patients who had undergone PAO without revasculari- zation, [1][2][3]5,[14][15][16][17] and symptoms were reported in 6 of the 11 cases (Table 1). The remaining 3 patients underwent internal trapping with OA-PCA bypass, which prevented cerebral infarction in 2 cases.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Therefore, reconstruction of the parent artery is particularly important while repairing aneurysms of the fetal-type PCA. 4,5 The approach to PCA aneurysms varies greatly depending on the site. Furthermore, bypass revascularization of the PCA is rarely performed, and there are few reports on its indications and therapeutic effects.…”

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confidence: 99%

Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases

Kikuta

Yamaguchi

Ishikawa

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Unlike in aneurysms of the adult-type posterior cerebral artery (PCA), in aneurysms of the fetal-type PCA, parent artery occlusion (PAO) results in vascular insufficiency and major ischemic strokes. Preservation or reconstruction of fetal-type PCAs is necessary to prevent these complications. Furthermore, it is necessary to select an appropriate bypass method and approach for revascularization of the PCA. OBSERVATIONS The authors report 2 cases of aneurysms of fetal-type PCAs that were successfully treated with PAO with revascularization. A 38-year-old man with a large unruptured right PCA aneurysm at the postcommunicating (P2) segment underwent trapping with superficial temporal artery–PCA bypass via the anterior temporal and subtemporal approaches. In addition, a 45-year-old woman with a left PCA aneurysm at the quadrigeminal (P3)–cortical (P4) segments resulting in subarachnoid hemorrhage underwent proximal clipping of the P3 segment via the occipital interhemispheric approach with an occipital artery–PCA bypass. Although she had perforator infarction, major ischemic stroke was prevented, and aneurysm occlusion was accomplished in both cases. LESSONS Aneurysms of fetal-type PCAs pose a risk of ischemia due to PAO. The combined use of bypass and revascularization should be considered to prevent major ischemic stroke after occlusion of the fetal-type PCA. However, perforator infarction is a concern.

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Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion

Cited by 12 publications

References 15 publications

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3

Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases

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