Treatment strategies for dissecting aneurysms of the posterior cerebral artery

Park, Wonhyoung; Kwon, Do Hoon; Ahn, Jae Sung; Lee, Sung Ho; Park, Jung Cheol; Kwun, Byung Duk

doi:10.1007/s00701-015-2526-1

Cited by 21 publications

(41 citation statements)

References 42 publications

(59 reference statements)

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“…The majority of patients were in 30-50 years in this series, and the mean age was 40.1 years, a little older than previously reported. As some paper reported [9,11], the most common presentation in our case series was SAH (53.8%) secondary to aneurysmal rupture presenting with headache and focal neurological deficits corresponding to the vascular territory of the PCA. A complaint of headache prompted diagnostic inquiry in 6 of our 26 patients, which is the important sign to vulnerable dissecting, especially in young population.…”

Section: Discussion Pecific Morphologic and Clinical Features Of Pca mentioning

confidence: 50%

“…Park et al repored that six of the ten patients who received a PAO without a balloon test occlusion (BTO) experienced PCA territory infarction, whereas only one of the five patients who received a PAO after passing the BTO experienced an infarction. thus, they stated that BTO before PAO was helpful in identifying candidates who truly needed surgical revascularization [11]. But we did not perform test occlusion prior to treatment in our series.…”

Section: Pao and Proximal Paomentioning

confidence: 82%

“…The basic management for endovascular occlusion of a dissecting aneurysm is to place the permanent occlusion device at the dissected site in the true lumen and then collapse the false lumen to induce thrombosis [14]. It is very important to keep in mind the anatomy of the PCA and its perforators during treatment because any decrease or obstruction of blood flow in the main PCA branches and/or perforators can cause cerebral infarction with significant morbidity [11]. Nevertheless, the exact location of the intimal flap where the dissection begins is difficult to identify.…”

Section: Pao and Proximal Paomentioning

confidence: 99%

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Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management

et al. 2017

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Backgroud: We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods: From June 2006 to July 2013, 26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution. Fourteen patients had ruptured aneurysms, and twelve patients had unruptured aneurysms. The endovascular modalities were the following: 1) PAO (n = 19), 2) palliative embolization (n = 5), and 3) proximal PAO (n = 2). Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results: The procedure was technically successful in all cases. In the PAO and proximal PAO group, all of the immediate angiography showed occlusion of the parent vessel, and follow-up imaging showed no recurrence of the aneurysms. In the palliative embolization group, one of five patients was died of rebleeding after the procedure, and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred. Five procedure related complications occurred totally: rebleeding (n = 1), hemiparesis (n = 2), and hemianopsia (n = 2). Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted. Sacrificing the parent artery appears to be well tolerated for distal segment of PCA. We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location. However, palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.

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Section: Discussion Pecific Morphologic and Clinical Features Of Pca mentioning

confidence: 50%

Section: Pao and Proximal Paomentioning

confidence: 82%

Section: Pao and Proximal Paomentioning

confidence: 99%

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Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management

et al. 2017

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“…The diagnosis of dissecting aneurysm was evaluated from the radiologic findings like 1) visualization of double lumens in MR or 2) pearl and string sign (ectatic segment with stenosis), 3) contrast stagnation and 4) blood like blister. 27)…”

Section: Inclusion Criteriamentioning

confidence: 99%

Role of microsurgery for treatment of posterior circulation aneurysms in the endovascular era

Kim

Heo

Byun

et al. 2020

J Cerebrovasc Endovasc Neurosurg

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Objective: Several studies have reported that the outcomes of endovascular treatment were superior to those of microsurgical treatment for posterior circulation aneurysms. Thus, this study compared outcomes of endovascular and microsurgical treatment for posterior circulation aneurysms and assess the usefulness of microsurgery in these patients. Methods: Outcomes were retrospectively evaluated after endovascular and microsurgical treatment of 621 posterior circulation aneurysms. The 621 aneurysms included 187 treated by surgical clipping and 434 treated by endovascular coiling. Results: In patients with unruptured aneurysms the rates of residual lesions and retreatment were significantly lower in those who underwent microsurgical than endovascular treatment. However immediate postoperative and 6 month follow-up Glasgow outcome scale (GOS) scores did not differ significantly in the two groups. In patients with ruptured aneurysms, the rates of residual lesions and retreatment were significantly lower in the microsurgery than in the endovascular treatment group. Even so immediate postoperative and 6 month follow-up GOS scores did not differ significantly in the two groups. Conclusions: Endovascular treatment has increasingly become an alternative modality for microsurgery in posterior circulation aneurysm, whereas the indication for microsurgery is greatly reduced. However, the absolute number of microsurgery is maintained showing that it is a still valuable technique, as advances in endovascular or stent-assisted coiling have not solved many of the challenges inherent in the management of complex aneurysms. Hence, the advantages and limitations of both modalities must be carefully concerned in posterior circulation aneurysm to obtain favorable outcome.

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

40 Posterior Cerebral Artery Aneurysms

Goehre

Jahromi

Lehečka

et al. 2018

Decision Making in Neurovascular Disease

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Treatment strategies for dissecting aneurysms of the posterior cerebral artery

Abstract: PAO for PCA-dissecting aneurysm was effective in preventing recurrence. In addition, BTO before PAO was helpful in identifying candidates who truly needed surgical revascularization.

Cited by 21 publications

References 42 publications

Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management

Dissecting aneurysms of the distal segment of the posterior cerebral artery: clinical presentation and endovascular management

Role of microsurgery for treatment of posterior circulation aneurysms in the endovascular era

40 Posterior Cerebral Artery Aneurysms

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