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

Abstract

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.

Keywords: Posterior communicating artery aneurysm; dual-microcatheter technique; endovascular treatment; rupture; stent-assisted coiling.

Figure 1.

The left internal carotid artery angiogram showed a 10.5 mm aneurysm arising from the distal segment of left PCoA (a). Left vertebral angiography with carotid compression showed the aneurysm via posterior communicating artery (b). Three-dimensional vascular reconstruction showed the aneurysm (c). The stent-microcatheter was navigated from left ICA-PCoA and delivered into PCA. Another microcatheter was introduced over micro-guidewire from left vertebral artery and navigated into the aneurysm (d). Final angiogram showed the aneurysm was complete occlusion by stent-assisted coiling (e). The white arrows showed the two ends of the stent (f). The aneurysm showed complete occlusion with PCoA patency at 26-month angiographic follow-up (g).