[Endovascular treatment of posterior cerebral artery aneurysm: analysis of 21 patients].
Youxiang LiAihua LiuMing LüChuhan JiangYouping ZhangXinjian YangJingbo ZhangPeng JiangZhongxue WuZhongcheng Wang
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Abstract:
To investigate the effect of endovascular treatment on posterior cerebral artery (PCA) aneurysm.The clinical data of 21 patients with PCA aneurysm, 12 males and 9 females, aged 3 - 60, totally 22 aneurysms, 3 located in the P1 segment, 16 (in 15 patients) on the P2 segment, and 3 being serpentine aneurysms and involving P2-3 segment, were analyzed. One patients gave up treatment, 6 patients, with 7 aneurysms, underwent aneurysm sac occlusion, and 14 patients underwent parent vessel occlusion.Complete aneurysm sac occlusion was achieved in 5 patients with 6 aneurysms, and incomplete occlusion was achieved in 1 patient who died of bleeding of aneurysm the next day after the operation. All 14 patients undergoing parent vessel occlusion survived without aneurysm detected by angiography, among which 3 presented hemianesthesia of the contralateral side and 2 recovered completely.Endovascular treatment is safe and effective for PCA aneurysm.Keywords:
Posterior cerebral artery
Posterior communicating artery
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A series of 10 cases of posterior cerebral artery (PCA) aneurysms were retrospectively reviewed. There were five men and five women aged 38 to 68 years (mean 57.5 years). Seven patients presented with subarachnoid hemorrhage. Two aneurysms were found incidentally during clinical examination for stroke. One aneurysm was associated with moyamoya disease. All aneurysms were saccular. The aneurysms arose from the P1 segment in three patients, the P1/P2 junction in three patients, the P2 segment in three patients, and the P3 segment in one patient. Two patients died before operation and one patient refused surgery. Aneurysmal clipping was performed for seven patients. All aneurysms except the P2 and the P3 aneurysms were treated via the pterional approach. Four patients had excellent outcome, but one patient with a P3 aneurysm developed homonymous hemianopsia due to thrombosis of the parent vessel and another patient with a P2 aneurysm had moderate disability from the initial insult. Coil embolization has been indicated as the first choice of therapy, but PCA aneurysms are good candidates for direct clipping.
Clipping (morphology)
Posterior cerebral artery
Posterior communicating artery
Moyamoya Disease
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Complex middle cerebral artery (MCA) aneurysms, including aneurysms that are sizeable (large or giant), fusiform, wide‑necked or calcified, remain a significant challenge during microsurgical clipping or endovascular coiling as treatment strategies. In the present study, a retrospective analysis of cases of this type of aneurysm treated between August 2012 and December 2019 was performed. From the hospital's database, a total of 13 patients (7 males and 6 females) with a mean age of 39.0 years (range, 13‑65 years) were identified. The mean size of the aneurysms was 17.5 mm (range, 3.9‑35.0 mm). A total of four patients (30.8%) had ruptured aneurysms and nine (69.2%) had unruptured aneurysms. All aneurysms were treated by proximal occlusion of the parent artery, trapping or excision combined with cerebral revascularization. The bypasses performed included 10 extracranial‑intracranial bypasses and 3 intracranial‑intracranial bypasses (1 end‑to‑end re‑anastomosis, 1 interpositional graft and 1 end‑to‑side reimplantation). Postoperative angiography confirmed that the bypass patency was 92.3% and the clinical outcomes were indicated to be favorable, with a modified Rankin Scale score ≤2 in 12 out of 13 patients (92.3%) at the last follow‑up. Taken together, the results of the present analysis suggested that treatment strategies for complex MCA aneurysms should depend on the status and characteristics of the aneurysm, including aneurysm size, location and morphology. For aneurysms that lack perforating arteries in the aneurysm dome, clip trapping or aneurysm excision with or without bypass are preferred as treatment strategies. When there are perforating arteries (particularly the lenticulostriate artery) arising from the aneurysm dome, however, the aneurysms should be treated with bypass followed by proximal occlusion of the parent artery or clip reconstruction.
Clipping (morphology)
Endovascular coiling
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2002년 12월에서 2013년 12월까지, 인제대학교 부산백병원 Purpose: The objective of this study was to review the clinical outcome after treatment of distal posterior cerebral artery (PCA) aneurysms via endovascular approach. Materials and Methods: Eleven patients with 11 distal PCA aneurysms who were treated via endovascular approach in Inje University Busan Paik Hospital and Kosin University Gospel Hospital from December 2002 to December 2013 were retrospectively reviewed. Results: Among the 11 patients, there were 3 males (27.3%) and 8 females (72.7%). The mean age was 56.6 years (range 44–72 years) and the mean aneurysm size was 8.45 mm (3–30 mm). Four (36.4%) aneurysms were located in the P2 segment, 6 (54.5%) in the P3 segment and 1 (9.1%) in the P1/2 junction. Seven (63.6%) aneurysms were treated with preservation of the parent artery; and the remaining 4 (36.4%) aneurysms were treated with parent artery occlusion. After treatment, the overall complication rate was 27% with the morbidity rate of 9.1% and the mortality rate of 18%. Conclusion: Endovascular treatment of distal PCA aneurysm might be used to minimize neurologic deficit, considering the diverse and rich collaterals of posterior cerebral artery. Index terms Aneurysm Posterior Cerebral Artery Endovascular Techniques
Posterior cerebral artery
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Objective To investingate the safety and feasibility of endovascular therapy in posterior circulation aneurysms.Methods There were 14 patients with posterior circulation aneurysms in this group,8 aneurysms located in the apex of basilar artery,3 aneurysms in superior cerebellar artery,l aneruysms in posterior inferior cerebellar artery,2 dissect aneurysms in vertebral artery. 6 patients were treated with coiling,3 patients with balloon assisted coiling,4 patients with Neuroform stent assisted coiling,1 patient was with Neuroform stent. Results 11 patients received complete occlusion,3 patients receiced 95％ occlusion.There was no SAH within follow - up period. DSA was performed in 3 patients,there was no recurrence. The patient solo -treated with stent was followed up with DSA one month later,and the aneurysm disappeared.Conclusion Endovascular therapy is a valuable and safe method for treatment of posterior circulation aneurysms.
Key words:
Intracranial aneurysm; Posterior circulation aneurysm; Endovascular therapy
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Objective To investigate the safety and feasibility of endovascular therapy in posterior circulation aneurysms. Method There were 47 patients with posterior circulation aneurysms in this group, 25 aneurysms located in the apex of basilar artery,4 aneurysms in superior cerebellar artery,5 aneurysms in posterior inferior cerebellar artery,2 aneurysms in anterior inferior cerebellar artery,9 dissect aneurysms in vertebral artery,other 2 patients suffered from multiple aneurysms. 23 patients were treated with coiling, 16 patients with balloon assisted coiling, 7 patients with Neuroform stent assisted coiling, 1 patient was with Neuroform stent. Results 37 patients received complete occlusion,9 patients received 95% occlusion. 1 patient combined with Moyamoya disease died of widespread brain swelling and cerebral hernia after the procedure. There was no SAH within follow-up period. DSA was performed in 5 patients, there was no recurrence. The patient solo-treated with stent was followed up with DSA one month later,and the aneurysm disappeared. Conclusions Endovascular therapy is a valuable and safe method for treatment of posterior circulation aneurysms, balloon remodeling and stent assistant embolization should be performed in wide-necked aneurysms.
Key words:
Intracranial aneurysm; Posterior circulation; Endovascular therapy
Posterior cerebral artery
Superior cerebellar artery
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Introduction
The purpose of this study was to evaluate the clinical presentation, endovascular treatment of aneurysms of the posterior cerebral artery and to compare the outcomes with contemporary Surgical and Endovascular Studies.Materials and methods
A retrospective evaluation of our clinical records over the last 10 years. Patients were initially evaluated clinically followed by cross-sectional imaging. The definitive diagnosis, angioarchitecture, planning and risk stratification was done on a digital subtraction angiography study. Out of a total of 27 patients with 28 aneurysms, the average age was 35.8 years (range: 16–60 years). 11(39%) aneurysms were on right side. Most 10(35.7%) were located on P1segment while 7(25%) were on P2segment. 5(17.8%) were on P1-P2 junctional segment, 4(14.3%) on P2-P3 junction and 2(7.14%) on P4 segments of PCA. Most were 7(25%) were small dissecting type. The rest included completely thrombosed aneurysm (2), bleb blister-like (1), large dissecting (3), partially thrombosed (6), giant (3), saccular (1), serpentine (2) and fusiform (3). Comparison was done with other large scale surgical and endovascular series of PCA aneurysms and the outcomes were compared. Most of the aneurysms were ruptured with acute bleeds (48.2%) and 8 patients had cranial nerve palsy from mass effect. Third cranial nerve (5 patients) was most commonly involved, followed by sixth cranial nerve (3 patients) palsies. One patient had seventh cranial nerve palsy. Visual abnormalities were present in 8 patients (29%) with cerebral ischemic infarcts in 2 patients (7.4%). Seizures were the presenting feature in a single patient with completely thrombosed aneurysm. The commonest association was internal acrotid artery stenosis or occlusion seen in five patients (21.4%). Procedure related complications were seen in 9 patients (33.3%) with spontaneous cure in three patients. Two patients were managed conservatively.Results
Most of the patients (18) were treated by endovascular coiling. Out of these one underwent balloon test occlusion and one patient underwent balloon-assisted coiling. Intra-luminal coiling was done in three patients, whereas 15 patients were treated by parent vessel occlusion and inside-out coiling. Glue was used in one patient, while one patient was lost to follow-up. All occluded aneurysms were stable on follow up studies done at 6month interval.Conclusion
Aneurysms of the PCA are rare with an incidence of 1% of all aneurysms. Clinical presentation is variable with bleeds, cranial nerve palsies, visual field defects or a combination. Endovascular treatment with either parent vessel occlusion or selective occlusion of the aneurysm with coils is safe and effective with good outcomes.Disclosures
P. Mondel: None. R. Saraf: None. U. Limaye: None.Digital subtraction angiography
Posterior cerebral artery
Posterior communicating artery
Oculomotor nerve palsy
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Objective To preliminarily investigate the safety and efficacy in patients with complex posterior cerebral artery ( PCA) aneurysms treated by coil embolization and endovascular stenting. Methods The clinical data of 4 patients with complex PCA aneurysms treated with stent implantation and endovascular coil embolization in the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retrospectively.Results Four patients had 4 PCA aneurysms ( 3 at the PI-2 segment and 1 at the P2 segment) ,and one of them was a dissecting aneurysm,three were widenecked aneurysms.Two of them were ruptured and 2 were unruptured aneurysms.All stenting were implanted successfully.Two aneurysms were embolized loosely and 2 were embolized tightly.No procedure-related complications occurred.Follow-up angiography were performed at 3 months after the procedure showed that all the aneurysms did not developed,the parent arteries were patent,and no in-stent stenosis was observed. Clinical follow-up for 3 to 14 months,4 patients recovered well,no rebleeding and ischemic complications occurred.Conclusion The treatment of complex PCA aneurysm with stents is relatively safe, and the short-term efficacy is satisfactory.It is an effective therapeutic means for preserving the parent arteries. Its long-term efficacy remains to be further evaluated in large sample studies.
Posterior cerebral artery
Endovascular coiling
Posterior communicating artery
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Objectives
To summarize the characteristics of early cortical branch (ECB) aneurysms of the middle cerebral artery (MCA) and to investigate the feasibility, safety, and efficacy of endovascular treatment of aneurysms on this site.
Methods
From January 2012 to June 2014, the angiographic data of 146 patients with MCA aneurysm treated with endovascular treatment at the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were collected. The ECB aneurysms were screened. Their clinical characteristics, cerebral angiographic results, treatment process, and follow-up results were analyzed retrospectively.
Results
A total of 32 patients with 33 ECB aneurysms were screened (including 1 early bilateral branch aneurysm), among them, 21 were early frontal artery aneurysms, 12 were early temporal artery aneurysms, 27 (81.8%) were wide-necked aneurysms. All the treatments of the patients were successfully, including 17 patients treated with coils alone, 3 with balloon-assisted coil embolization, and 13 with stent-assisted coil embolization. The postoperative immediate angiography showed that the aneurysms of 9 patients (27.3%) were packed densely, 4 patients had tumor neck development (12.1%), and 20 had (60.6%) aneurysm body development. One patient (3.1%) had intraoperative aneurysm hemorrhage, and after being treated with hematoma evacuation and decompressive craniectomy, he became better. The imaging follow-up of 21patients (63.6%) ranged from 3 to 14 months (mean 5.7±3.5 months). The aneurysms of 15 patients were embolized completely, 3 had further thrombosis, and 3 had neck recurrence. They were not treated again and were followed up continuously. The clinical follow-up of 31 patients (93.9%) ranged from 10 to 42 months (mean 20.3±8.9). No new nervous system symptoms or aneurysm rebleeding were observed.
Conclusions
The ECB aneurysms are different from bifurcation aneurysms. The aneurysm morphology is complex and the positions are special. Endovascular treatment is technically safe and. feasible
Key words:
Intracranial aneurysm; Middle cerebral artery; Endovascular Procedures; Early cortical branch
Anterior communicating artery
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Distal cerebral aneurysms are difficult to treat. Endovascular treatment (EVT) although challenging, in many cases allows sparing of the parent artery. If a deconstructive approach is necessary, EVT enables hyperselective catheterization with sacrificing only the branch on which aneurysm is located. Consequently much of the surrounding arterial circulation is spared. We describe our series of endovascularly treated distal cerebral aneurysms in 2009. This is a retrospective review of seven consecutive patients (five women) with eight distal cerebral aneurysms (four ruptured) who underwent embolization in 2009. Patient ages ranged from 44 to 69 years. Aneurysm size distribution was: seven small (0-10 mm) and one large (11-24 mm). Two aneurysms required a deconstructive approach. Embolization was performed with coils in six cases, and with liquid embolic material Onyx in two cases. Endovascular treatment was successful in all cases. Immediate angiograms revealed complete occlusion in six aneurysms, none with neck remnants, and incomplete occlusion in two aneurysms. On first follow-up (3-6 month) obtained in six patients, five aneurysms showed stabile occlusion, and one recanalization due to coil impaction. None of the patients died. One patient had neurological deficit GOS (Glasgow Outcome Scale) score three caused by parent artery occlusion, which gradually improved to GOS score 4. EVT is safe and effective technique for distal cerebral aneurysms.
Glasgow Outcome Scale
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