Recanalization after endovascular occlusion of a dissecting aneurysm of the posterior cerebral artery—A case report and review of the literature

Horie, Nobutaka; Kawahara, Ichiro; Kitagawa, Naoki; Morikawa, Minoru; Tsutsumi, Keisuke; Kaminogo, Makio; Nagata, Izumi

doi:10.1016/j.clineuro.2007.12.022

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…Others suggest occlusion only of the parent artery without packing the aneurysm cavity especially for giant or extremely lobulated aneurysms because parent artery occlusion alone can lead to decreased pressure within the aneurysm sac, which will later collapse without causing an occupying effect ( 18 ). However, this embolizing approach has been reported to have a high short-term recurrence rate and a high morbidity after hemorrhage caused by recurrence ( 19 ). In our study, we used a strategy of occluding both the aneurysm cavity and the parent artery at the same time without increasing complications caused by the occupying effect of aneurysm packing.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Cerebral Aneurysms of the Posterior Cerebral Artery

Wang

et al. 2021

Front. Neurol.

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Purpose: To investigate the safety and efficacy of endovascular embolization of cerebral aneurysms at the P1–P3 segments of the posterior cerebral artery (PCA).Materials and Methods: Seventy-seven patients with 77 PCA aneurysms who were treated with endovascular embolization were enrolled, including 35 (45.5%) patients with ruptured aneurysms and 42 (54.5%) with unruptured ones. The pretreatment clinical data and aneurysm occlusion status after treatment and at follow-up were analyzed.Results: All patients were successfully treated endovascularly, including coiling alone in 10 (13.0%) patients, stent-assisted coiling in 18 (23.4%), parent artery occlusion in 25 (32.5%), and pipeline embolization device (PED) in 24 (31.2%). Complete occlusion was achieved in 48 (62.3%) aneurysms, residual neck in 4 (5.2%), and residual aneurysm in the other 25 (32.5%) at the end of embolization. Periprocedural complications occurred in eight patients, including acute thrombosis in seven (9.1%) and intraprocedural subarachnoid hemorrhage in one (1.3%), with the total complication rate of 10.4%. Follow-up was performed in 60 patients (77.9%) for 42 ± 11 months; the mRS score was 0–2 in 55 (91.7%) patients, three in four patients (6.7%), and six in one patient (1.7%). Fifty-three (88.3%) patients (53 aneurysms) had stable or complete occlusion, and seven (11.7%) patients had aneurysm recurrence or residual aneurysm. Among 19 patients treated with PED at follow-up, 15 aneurysms (78.9%) proceeded to complete occlusion while four (21.1%) aneurysms showed residual aneurysm.Conclusion: Endovascular embolization remains a good choice of treatment with high safety and efficacy for posterior cerebral artery aneurysms.

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Section: Discussionmentioning

confidence: 99%

Endovascular Management of Cerebral Aneurysms of the Posterior Cerebral Artery

Wang

et al. 2021

Front. Neurol.

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“…However, all three cases of PCA-dissecting aneurysms that were treated with stentassisted coil embolization required retreatment because of angiographic recurrence (cases 13, 16 and 17) ( Table 1). Other studies also report that PCA-dissecting aneurysms frequently recur after coil embolization [3,15,36]. In addition, placing the stent into the dissected segment carries the risk of perforation and rupture; moreover, the antiplatelet therapy that is needed to prevent in-stent thrombosis adds to the risk of hemorrhagic complications [37].…”

Section: Choice Of Treatment For Pca-dissecting Aneurysmsmentioning

confidence: 99%

Treatment strategies for dissecting aneurysms of the posterior cerebral artery

et al. 2015

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“…In a reported surgical series, the morbidity was 28.5% after treatment for the distal segment of PCA aneurysm [14]. These aneurysms constitute a relatively uncommon subgroup of intracranial aneurysms.…”

Section: Treatment Strategymentioning

confidence: 99%

“…At present, endovascular occlusion of the dissected site has been accepted as a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated or adequate collateral circulation is present. 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].…”

Section: Pao and Proximal Paomentioning

confidence: 99%

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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Recanalization after endovascular occlusion of a dissecting aneurysm of the posterior cerebral artery—A case report and review of the literature

Cited by 15 publications

References 21 publications

Endovascular Management of Cerebral Aneurysms of the Posterior Cerebral Artery

Endovascular Management of Cerebral Aneurysms of the Posterior Cerebral Artery

Treatment strategies for dissecting aneurysms of the posterior cerebral artery

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

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