Treatment strategies for dissecting aneurysms of the posterior cerebral artery

• Published in: Acta neurochirurgica Vol. 157; no. 10; pp. 1633 - 1643
• Main Authors: Park, Wonhyoung, Kwon, Do Hoon, Ahn, Jae Sung, Lee, Sung Ho, Park, Jung Cheol, Kwun, Byung Duk
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.10.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aneurysm, Dissecting - surgery; Cerebral Revascularization - adverse effects; Clinical Article - Vascular; Embolization, Therapeutic - adverse effects; Endovascular Procedures - adverse effects; Female; Humans; Interventional Radiology; Intracranial Aneurysm - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Surgical Orthopedics; Intracranial aneurysms; Therapeutic occlusion; Cerebral revascularization; Dissection; Posterior cerebral artery; Endovascular procedures
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-015-2526-1

Background Dissecting aneurysms of the posterior cerebral artery (PCA) are rare and difficult to treat because of their deep and unfamiliar locations and unusual shapes. Although several treatment modalities have been proposed, none have generated satisfying results. Our experiences with PCA-dissecting aneurysms are reviewed and the treatment strategies discussed. Methods All consecutive patients with PCA-dissecting aneurysm who were treated in a tertiary referral hospital between January 1998 and March 2014 were identified by retrospective review. Their clinical characteristics, radiological findings, treatment modalities and outcomes were documented. Results Of the 21 patients with 21 PCA-dissecting aneurysms, 9 had subarachnoid hemorrhage and 3 had acute infarction of the thalamus at presentation. The aneurysms involved P1 ( n  = 4), the P1–2 junction ( n  = 3), mid-P2 ( n  = 6), P2A ( n  = 3), P2P ( n  = 1) and the P2-3 junction ( n  = 4). The aneurysm shapes were as follows: fusiform ( n  = 12), partially thrombosed ( n  = 8) and blood blister-like aneurysms ( n  = 1). The mean size was 16.6 ± 9.7 mm. Parent artery occlusion (PAO) without bypass ( n  = 15), PAO with bypass ( n  = 2), stent-assisted endosaccular coiling ( n  = 3) and stent placement only ( n  = 1) were performed. All three patients who underwent stent-assisted endosaccular coiling and the single patient who underwent PAO without bypass developed aneurysm recurrence. Six of the ten patients who received a PAO without a balloon test occlusion (BTO) experienced PCA territory infarction, whereas only one of the five patients who received a PAO after passing the BTO experienced an infarction. Conclusions PAO for PCA-dissecting aneurysm was effective in preventing recurrence. In addition, BTO before PAO was helpful in identifying candidates who truly needed surgical revascularization.