Endovascular Treatment of Ruptured Dissecting Aneurysms on the P2-3 Segment of the Posterior Cerebral Artery: A Report of Two Cases

Abstract

Intracranial ruptured dissecting aneurysms can have fatal outcomes. Among them, posterior cerebral artery dissecting aneurysm with hemorrhage is uncommon but usually fatal due to its deep location and proximity to surrounding critical structures. Most previously published reports on this type of aneurysm have concluded that the neurologic outcome can be improved with the use of certain surgical or endovascular approaches. However, in severe cases with a poor initial clinical status, patient improvement should not be expected. We report two cases of P2-3 segment ruptured dissecting aneurysms that were treated by external ventricular drainage for control of increased intracranial pressure followed by one-stage endovascular treatment for the aneurysm.

Stent-Assisted Coil Embolization for Acute Ruptured Dissecting Aneurysm at the P2 Segment of the Posterior Cerebral Artery: A Case Report

“…2) In contrast, PCA dissecting aneurysm is extremely rare, occurs at a younger age, and shows female predominance, with only a few reported cases. [3][4][5][6][7] The P2 segment is the most common location for PCA dissecting aneurysms. 4,6) Trauma or stress of the arterial wall of the PCA along the tentorial edge may be a cause of the development of PCA dissecting aneurysm.…”

“…12) Therefore, stent-assisted coil embolization has recently been used for the treatment of acute ruptured PCA dissecting aneurysm. 3,4,6) The problem with stent-assisted coiling is the essential administration of antiplatelet agents prior to stenting even in the patients with acute ruptured aneurysms, which may increase the risk of hemorrhage, rupture, or extension of the lesion. Furthermore, long-term antiplatelet therapy is essential, especially in patients with acute ruptured aneurysms who are at risk for hemorrhagic events.…”

“… 12) Therefore, stent-assisted coil embolization has recently been used for the treatment of acute ruptured PCA dissecting aneurysm. 3 , 4 , 6) …”

“…2) Saccular aneurysms of the PCA usually occur only at the P1 or the P1-P2 segment, whereas dissecting aneurysms of the PCA usually occur at the P2 or P2-P3 segment. 3) Dissecting aneurysms of the PCA can be posttraumatic or spontaneous. 4) Here, we report a case of ruptured PCA dissecting aneurysm to form two aneurysmal sacs, successfully treated with stent-assisted coil embolization in the acute phase.…”

“… 2) Saccular aneurysms of the PCA usually occur only at the P1 or the P1–P2 segment, whereas dissecting aneurysms of the PCA usually occur at the P2 or P2–P3 segment. 3) Dissecting aneurysms of the PCA can be posttraumatic or spontaneous. 4) …”