Tuberothalamic Artery Infarctions following Coil Embolization of Ruptured Posterior Communicating Artery Aneurysms with Posterior Communicating Artery Sacrifice

Endo, Hidenori; Satô, Kiyoshi; Kondo, Ryushi; Matsumoto, Yukihiro; Takahashi, Akira; Tominaga, Teiji

doi:10.3174/ajnr.a2828

Cited by 49 publications

(46 citation statements)

References 22 publications

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“…1 However, ischemic complications following coil embolization of PcomA aneurysms are not fully understood, especially when the PcomA is sacrificed. 16 Although the Allcock test is considered useful for evaluating collateral blood flow, to predict postoperative ischemic complications of PcomA sacrifice, the ramifications of sacrificing the PcomA orifice in patients with PcomA aneurysms are still unknown. Endo et al 16 reported 7 cases of tuberothalamic artery territory infarction following coil embolization of 14 ruptured PcomA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…16 Although the Allcock test is considered useful for evaluating collateral blood flow, to predict postoperative ischemic complications of PcomA sacrifice, the ramifications of sacrificing the PcomA orifice in patients with PcomA aneurysms are still unknown. Endo et al 16 reported 7 cases of tuberothalamic artery territory infarction following coil embolization of 14 ruptured PcomA aneurysms. PcomA sacrifice was regarded as unsafe, even with a preoperative Allcock test confirming retrograde filling of the PcomA by the posterior cerebral artery.…”

Section: Discussionmentioning

confidence: 99%

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Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Cho¹,

Lee²,

Kim³

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Cho¹,

Lee²,

Kim³

et al. 2013

AJNR Am J Neuroradiol

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“…Endo et al used coil embolization and PcoA occlusion to treat 14 patients with ruptured PcoA aneurysms,4 confirming retrograde filling of PcoA through P1 by the Allcock test before each procedure. Nevertheless, half of their patients developed postprocedural infarcts in territories of tuberothalamic arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Endo et al were the first to address PcoA compromise in PcoA aneurysms, finding that 50% of patients thus treated suffered infarction after coil embolization. They attributed the above outcomes to compromise in instances of PcoA dominance 4. Cho et al have nevertheless argued that compromise of hypoplastic PcoA variants, in conjunction with coil embolization of PcoA aneurysms, appears to be safe with no major consequences 3.…”

Section: Introductionmentioning

confidence: 99%

Selective compromise of hypoplastic posterior communicating artery variants with aneurysms treatable by coil embolization: clinical and radiologic outcomes

Choi

Cho

Yoo

et al. 2018

J NeuroIntervent Surg

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BackgroundPosterior communicating artery (PcoA) compromise may serve as adjunctive treatment in patients with hypoplastic variants of PcoA who undergo coil embolization of PcoA aneurysms. However, procedural safety and the propensity for later recanalization are still unclear.ObjectiveTo evaluate clinical and radiologic outcomes of coil embolization in this setting, focusing on compromise of PcoA.MethodsAs a retrospective review, we examined 250 patients harboring 291 aneurysms of hypoplastic PcoAs, all consecutively treated by coil embolization between January 2004 and June 2016. PcoA compromise was undertaken in conjunction with 81 of the treated aneurysms (27.8%; incomplete 53; complete 28). Medical records and radiologic data were assessed during extended monitoring.ResultsDuring the mean follow-up of 33.9±24.6 months (median 36 months), a total of 107 (36.8%) coiled aneurysms showed recanalization (minor 50; major 57). Recanalization rates were as follows: PcoA preservation 40.5% (85/210); incomplete PcoA occlusion 34.0% (18/53); complete PcoA occlusion 14.3% (4/28). Aneurysms >7 mm (HR 3.40; P<0.01), retreatment for recanalization (HR 3.23; P<0.01), and compromise of PcoA (P<0.01) emerged from multivariate analysis as significant risk factors for recanalization. Compared with PcoA preservation, complete PcoA compromise conferred more favorable outcomes (HR 0.160), whereas incomplete compromise of PcoA fell short of statistical significance. Thromboembolic infarction related to PcoA compromise did not occur in any patient.ConclusionPcoA compromise in conjunction with coil embolization of PcoA aneurysms appears safe in hypoplastic variants of PcoA, helping to prevent recanalization if complete occlusion is achieved.

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“…However, if the PCoA is obliterated near the ICA, the reverse flow of the PCoA from the PCA will perfuse ATPAs, and the diameter of the P1 segment is important. 17) A super-selective balloon test occlusion of the PCoA is seemed to be considered. 18) In our case, the aneurysmal neck was small, very close to the P1-P2 segment, and more than 5 mm away from PMA; therefore, we planned a short-segment internal trapping as a third session.…”

Section: Case Presentationmentioning

confidence: 99%

A Ruptured Large Thrombosed True Posterior Communicating Artery Aneurysm Treated with Endovascular Treatment Three Times

Kawada

Sugiu

2019

JNET

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We report a case of ruptured large thrombosed true posterior communicating artery (PCoA) aneurysm and consider its treatment. Case Presentation: A 71-year-old male patient had a left ruptured large thrombosed true PCoA aneurysm (maximum diameter 23 mm) with a small neck. Intra-aneurysmal coil embolization via the internal carotid artery was performed to preserve the premammillary artery (PMA). The adjunctive technique could not be used because the diameter of the PCoA was 1.5 mm. The result was a neck remnant and the aneurysm was recanalized. After 14 months, similar treatment was performed, and the aneurysm was recanalized again. The acute and twisted angle of the PCoA origin and the thinness of the PCoA were considered as factors for incomplete embolization. Because the distance between the origin of the PMA and aneurysmal neck was 5 mm, short-segment internal trapping of the aneurysm was performed 13 months after the second embolization. As a result, the PMA was no longer visualized on DSA; however, he had no neurologic deficit. The aneurysm remained obliterated after 7 months. Conclusion: Making a tight intra-aneurysmal coil embolization of a large thrombosed true PCoA aneurysm is difficult. If there is a certain distance between the PMA and the aneurysm neck, short-segment internal trapping might be useful to treat it.

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Tuberothalamic Artery Infarctions following Coil Embolization of Ruptured Posterior Communicating Artery Aneurysms with Posterior Communicating Artery Sacrifice

Cited by 49 publications

References 22 publications

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Selective compromise of hypoplastic posterior communicating artery variants with aneurysms treatable by coil embolization: clinical and radiologic outcomes

A Ruptured Large Thrombosed True Posterior Communicating Artery Aneurysm Treated with Endovascular Treatment Three Times

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