Endovascular treatment of ruptured true posterior communicating artery aneurysms

Yang, Yonglin; Su, Wandong; Meng, Qinghai

doi:10.5137/1019-5149.jtn.10137-13.1

Cited by 5 publications

(8 citation statements)

References 12 publications

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“…Only surgical treatment was performed in early cases; however, technical advances achieved in endovascular therapy have permitted the successful treatment of true PCoA aneurysms. 5,6) To preserve perforators of PCoA, direct clipping or intra-aneurysmal embolization is initially considered. In our case, we selected embolization as the aneurysm was large and thrombosed, and we found two disadvantages of the therapy.…”

Section: Resultsmentioning

confidence: 99%

“…However, three giant true PCoA aneurysms and less than 10 cases of large true PCoA aneurysms, including our case, have been reported. [3][4][5][6][7] Before the treatment of true PCoA aneurysms, it is necessary to evaluate the distance between the neck of them and ICA or PCA. Most true PCoA aneurysms arise within 2-3 mm from the origin of the PCoA near the ICA.…”

Section: Case Presentationmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

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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“…1 The literature on endovascular management of such lesions is limited and the angiographic follow-up rate is considerably lower ( Table 3). [11][12][13][14][15][16][17][18][19] We retrospectively reviewed a series of eight TPCoA aneurysms in our database to assess the safety and efficacy of endovascular treatment in such cases. In this study, most of the treated TPCoA aneurysms were ruptured (7/8, 85.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, endovascular treatment has been widely used in management of intracranial aneurysms and such strategy in managing TPCoA aneurysms is reported in a few case studies. [11][12][13][14][15][16][17][18][19] Munarriz et al 12 reported a case of successful endovascular coiling of a TPCoA aneurysm with subsequent angiographic stability. Another report from Guo et al 11 showed three such aneurysms, of which two were treated endovascularly without complications.…”

Section: Discussionmentioning

confidence: 99%

“…Given the low incidence of TPCoA aneurysms, only limited small endovascular experiences are available in the literature. [11][12][13][14][15][16][17][18][19] To the best of our knowledge, only 19 total endovascularly treated cases are published in the literature with only six cases followed angiographically. The safety and efficacy of endovascular therapy for TPCoA aneurysm are still unclear based on limited cases.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of true posterior communicating artery aneurysms: Endovascular experience in a single center

Liu

Wang

et al. 2019

Interv Neuroradiol

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Background and objective The true posterior communicating artery (TPCoA) aneurysms are rare and endovascular treatment for such lesions is limited in literature. Methods From January 2012 to March 2017, eight TPCoA aneurysms were treated endovascularly and included in our present study. The procedural complication and outcomes were assessed. Results Seven of eight aneurysms (87.5%) were ruptured. Stent-assisted coiling was used in one case that a stent was deployed via PCoA-ipsilateral P2 segment. The dual-microcatheter technique was used in one case. The remaining six cases were treated by coiling alone. One patient (12.5%) suffered perioperative complication, of which a coil herniated into parent vessel during the procedure without symptomatic stroke or other adverse event after the procedure. The initial embolization results showed complete occlusion in five cases and residual neck in three. Six patients (75%) had a mean of 15-month angiographic follow-up and two of them revealed recurrence (33.3%). Clinical follow-up was available in seven patients (87.5%) and all patients showed favorable clinical outcome with mRS score 0. Conclusion TPCoA aneurysms are rare and challenging lesions with high rupture rate in literatures. Endovascular treatment may be a feasible alternative for TPCoA aneurysms. Primary coiling, as well as adjunctive strategies, such as stent-assisted coiling or dual catheter techniques may be considered. Further study in a larger population is necessary.

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Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience

et al. 2022

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Purpose To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. Materials and methods Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9–85). Mean follow-up was 21 months (6–28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). Results In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete–complete occlusion (O’Kelly–Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0–1) was achieved in 24/25 (96%) of patients. Conclusion Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.

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Endovascular treatment of ruptured true posterior communicating artery aneurysms

Cited by 5 publications

References 12 publications

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

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

Treatment of true posterior communicating artery aneurysms: Endovascular experience in a single center

Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience

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