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

Abstract

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.

Bypass surgery for ruptured dissecting aneurysms of the proximal posterior cerebral artery: illustrative case

“…Most of the PCA dissecting aneurysms are located in the proximal PCA: 22.6% in the P1 segment, 12% in the P1-P2 junction, 46.7% in the P2 segment, and 18.6% in the P3 segment. 2 Risk for complication of endovascular treatment for PCA depends on the existence of perforating arteries. The perforating branches of the proximal PCA include TPA, short circumflex artery (SCxA), long circumflex artery (LcxA), and MPchA.…”

“…PubMed publications were searched using key terms such as “posterior cerebral artery dissection” and “dissecting aneurysm.” There were 33 cases of ruptured dissecting aneurysms of the proximal PCA, including the present case, as shown in Table 1 . 1 , 2 , 4–16 The mean age was 41.3 years, and 21 patients (63.6%) were male. The main location of the aneurysms was the P2 segment (60.6%), followed by the P1-P2 junction (33.3%).…”

A rare case of fusiform basilar trunk aneurysm

“…In this pediatric patient, endovascular treatment was chosen due to the challenge of treating large fusiform aneurysms in the posterior circulation [7] . Our goals were to both improve the patient's symptoms and prevent aneurysmal rupture.…”

Clinical Importance of the Persistent Primitive Trigeminal Artery in Vascular Lesions and Its Role in Endovascular Treatment

“…The BOT should be performed when the patient is awake to allow for real-time evaluation of neurological deficits. Additionally, mean arterial pressure can be reduced to 70% of baseline during the BOT to evaluate neurological deficits ( 35 ).…”

“…Therefore, if the PPTA stenoses, aggressive transluminal angioplasty is recommended. In MMD, the upper BA, SCA and PCA may be associated with aneurysms ( 35 ). The PPTA can be used as the path for endovascular coiling ( 76 ).…”