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Feasibility and midterm outcomes of endovascular embolization for true posterior communicating artery aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Endovascular treatment (EVT) of true posterior communicating artery (PcomA) aneurysms has been rarely reported. This study reports the outcomes on a single-center cohort with true PcomA aneurysms who underwent EVT.

Methods

Between June 2011 and June 2017, clinical data from 42 patients with 43 true PcomA aneurysms who underwent EVT were retrieved from a prospectively maintained single-center database. Endovascular techniques, perioperative complications, clinical outcomes, and angiographic results were retrospectively evaluated.

Results

All aneurysms were treated successfully. Treatment modalities included simple coiling in 30 aneurysms, balloon-assisted coiling in two, and stent-assisted coiling in 11 cases. Immediate angiograms showed complete occlusion in 23 aneurysms (53.5%), residual neck in 8 cases (18.6%), and residual sac in 12 (27.9%). No procedure-related complications or mortality were observed. Of the 34 aneurysms that underwent angiographic follow-up at an average duration of 7.1 months post-procedure, complete occlusion was achieved in 22 (64.7%), neck remnant in eight (23.5%), and residual sac in four (11.8%) aneurysms, respectively. Six aneurysms (18.2%) that underwent conventional coiling developed recanalization and required retreatment. Seven cases that received stent-assisted coiling did not develop recurrence. Clinical follow-up (mean, 24.3 months) of all patients demonstrated no neurologic deterioration or (re)bleeding.

Conclusion

EVT of the true PcomA aneurysm is a safe and feasible procedure but may be associated with recurrence in midterm follow-up, requiring close surveillance and potential retreatment.

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References

  1. Yoshida M, Watanabe M, Kuramoto S (1979) “True” posterior communicating artery aneurysm. Surg Neurol 11(5):379–381

    CAS  PubMed  Google Scholar 

  2. He W, Gandhi CD, Quinn J, Karimi R, Prestigiacomo CJ (2011) True aneurysms of the posterior communicating artery: a systematic review and meta-analysis of individual patient data. World Neurosurg 75(1):64–72 discussion 49

  3. He W, Hauptman J, Pasupuleti L, Setton A, Farrow MG, Kasper L, Karimi R, Gandhi CD, Catrambone JE, Prestigiacomo CJ (2010) True posterior communicating artery aneurysms: are they more prone to rupture? A biomorphometric analysis. J Neurosurg 112(3):611–615

    Article  PubMed  Google Scholar 

  4. Krayenbuhl HA, Yasargil MG, Flamm ES, Tew JM Jr (1972) Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 37(6):678–686

    Article  CAS  PubMed  Google Scholar 

  5. Muneda K, Yoshizu H, Terada H (2001) True posterior communicating artery aneurysm. No Shinkei Geka 29(2):163–168

    CAS  PubMed  Google Scholar 

  6. Timothy J, Sharr M, Doshi B (1995) Perils of a ‘true’ posterior communicating artery aneurysm. Br J Neurosurg 9(6):789–791

    Article  CAS  PubMed  Google Scholar 

  7. Kuzmik GA, Bulsara KR (2012) Microsurgical clipping of true posterior communicating artery aneurysms. Acta Neurochir 154(9):1707–1710

    Article  PubMed  Google Scholar 

  8. Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS (2015) The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 385(9969):691–697

    Article  PubMed  PubMed Central  Google Scholar 

  9. van Raamt AF, Mali WP, van Laar PJ, van der Graaf Y (2006) The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis 22(4):217–224

    Article  PubMed  Google Scholar 

  10. Tamargo RJ (2011) True posterior communicating artery aneurysms. World Neurosurg 75(1):49

    Article  Google Scholar 

  11. Sorimachi T, Fujii Y, Nashimoto T (2004) A true posterior communicating artery aneurysm: variations in the relationship between the posterior communicating artery and the oculomotor nerve. Case illustration. J Neurosurg 100(2):353

    Article  PubMed  Google Scholar 

  12. Rhoton AL Jr (2002) Aneurysms. Neurosurgery 51(4 Suppl):S121–S158

    PubMed  Google Scholar 

  13. Yang Y, Su W, Meng Q (2015) Endovascular treatment of ruptured true posterior communicating artery aneurysms. Turk Neurosurg 25(1):73–77

    PubMed  Google Scholar 

  14. Mitsuhashi T, Takeda N, Oishi H, Arai H (2015) Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm. Interv Neuroradiol 21(2):171–174

    Article  PubMed  PubMed Central  Google Scholar 

  15. Munarriz PM, Castano-Leon AM, Cepeda S, Campollo J, Alen JF, Lagares A (2014) Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 5(Suppl 12):S447–S450

    Article  PubMed  PubMed Central  Google Scholar 

  16. Guo J, Chen Q, Miao H, Feng H, Zhu G, Chen Z (2014) True posterior communicating artery aneurysms with or without increased flow dynamical stress: report of three cases. Clin Neurol Neurosurg 116:93–95

    Article  PubMed  Google Scholar 

  17. Almeida-Perez R, Espinosa-Garcia H, Alcala-Cerra G, de la Rosa-Manjarrez G, Orozco-Gomez F (2014) Endovascular coiling of a <<true>> posterior communicating artery aneurysm. Neurocirugia (Astur) 25(2):90–93

    Article  Google Scholar 

  18. Kubo M, Kuwayama N, Hirashima Y, Ohi M, Takami M, Endo S (2000) Endovascular treatment of unusual multiple aneurysms of the internal carotid artery-posterior communicating artery complex—case report. Neurol Med Chir (Tokyo) 40(9):476–479

    Article  CAS  Google Scholar 

  19. Meguro T, Terada K, Hirotune N, Nishino S, Asano T, Manabe T (2005) A case of ruptured true posterior communicating artery aneurysm with neurogenic pulmonary edema treated early by GDC embolization. No Shinkei Geka 33(10):1001–1004

    PubMed  Google Scholar 

  20. Yang ZG, Liu J, Ge J, Li ZF, Tian CO, Han J, Zhao R, Hong B (2016) A novel proximal end stenting technique for assisting embolization of a complex true posterior communicating aneurysm. J Clin Neurosci 28:148–151

    Article  PubMed  Google Scholar 

  21. Endo H, Sato K, Kondo R, Matsumoto Y, Takahashi A, Tominaga T (2012) Tuberothalamic artery infarctions following coil embolization of ruptured posterior communicating artery aneurysms with posterior communicating artery sacrifice. AJNR Am J Neuroradiol 33(3):500–506

    Article  CAS  PubMed  Google Scholar 

  22. Cho YD, Jung SC, Kim CH, Ahn JH, Kang HS, Kim JE, Han MH (2015) Posterior communicating artery compromise in coil embolization of posterior communicating artery aneurysms. Clin Neuroradiol 25(3):275–279

    Article  CAS  PubMed  Google Scholar 

  23. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34(6):1398–1403

    Article  PubMed  Google Scholar 

  24. Ries T, Siemonsen S, Thomalla G, Grzyska U, Zeumer H, Fiehler J (2007) Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 28(9):1755–1761

    Article  CAS  PubMed  Google Scholar 

  25. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38(5):1538–1544

    Article  PubMed  Google Scholar 

  26. Alghamdi F, Mine B, Morais R, Scillia P, Lubicz B (2016) Stent-assisted coiling of intracranial aneurysms located on small vessels: midterm results with the LVIS Junior stent in 40 patients with 43 aneurysms. Neuroradiology 58(7):665–671

    Article  PubMed  Google Scholar 

  27. Wang CC, Li W, Feng ZZ, Hong B, Xu Y, Liu JM, Huang QH (2017) Preliminary experience with stent-assisted coiling of aneurysms arising from small (<2.5 mm) cerebral vessels using the low-profile visualized intraluminal support device. AJNR Am J Neuroradiol 38(6):1163–1168

    Article  PubMed  Google Scholar 

  28. Aydin K, Arat A, Sencer S, Barburoglu M, Men S (2015) Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile LEO baby stents: initial and midterm results. AJNR Am J Neuroradiol 36(10):1934–1941

    Article  CAS  PubMed  Google Scholar 

  29. Zuo Q, Yang P, Lv N, Huang Q, Zhou Y, Zhang X, Duan G, Wu Y, Xu Y, Hong B, Zhao R, Li Q, Fang Y, Zhao K, Dai D, Liu J (2018) Safety of coiling with stent placement for the treatment of ruptured wide-necked intracranial aneurysms: a contemporary cohort study in a high-volume center after improvement of skills and strategy. J Neurosurg:1–7

  30. Lopes DK, Johnson AK, Kellogg RG, Heiferman DM, Keigher KM (2014) Long-term radiographic results of stent-assisted embolization of cerebral aneurysms. Neurosurgery 74(3):286–291

    Article  PubMed  Google Scholar 

  31. Brinjikji W, Lanzino G, Cloft HJ, Kallmes DF (2014) Patency of the posterior communicating artery after flow diversion treatment of internal carotid artery aneurysms. Clin Neurol Neurosurg 120:84–88

    Article  PubMed  Google Scholar 

  32. Daou B, Valle-Giler EP, Chalouhi N, Starke RM, Tjoumakaris S, Hasan D, Rosenwasser RH, Hebert R, Jabbour P (2017) Patency of the posterior communicating artery following treatment with the pipeline embolization device. J Neurosurg 126(2):564–569

    Article  PubMed  Google Scholar 

  33. Enriquez-Marulanda A, Ravindran K, Salem MM, Ascanio LC, Kan P, Srinivasan VM, Griessenauer CJ, Schirmer CM, Jain A, Moore JM, Ogilvy CS, Thomas AJ, Alturki AY (2019) Evaluation of radiological features of the posterior communicating artery and their impact on efficacy of saccular aneurysm treatment with the pipeline embolization device: a case series study. World Neurosurg,

  34. Kuhn AL, Dabus G, Kan P, Wakhloo AK, Puri AS (2018) Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms-analysis on aneurysm occlusion, vessel patency, and patient outcome. Interv Neuroradiol 24(4):363–374

    Article  PubMed  PubMed Central  Google Scholar 

  35. Roy AK, Howard BM, Haussen DC, Osbun JW, Halani SH, Skukalek SL, Tong F, Nogueira RG, Dion JE, Cawley CM, Grossberg JA (2018) Reduced efficacy of the pipeline embolization device in the treatment of posterior communicating region aneurysms with fetal posterior cerebral artery configuration. Neurosurgery 82(5):695–700

    Article  PubMed  Google Scholar 

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Funding

This work was supported in part by the National Natural Science Foundation of China (No. 81571126), the National Key R&D program of China (2016YFC1300700) and the project on research and application of effective intervention techniques for high risk population of stroke from the National Health and Family Planning Commission in China (GN-2016R0012).

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Author notes

  1. CW and RZ contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Changhai Stroke Center, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Chuanchuan Wang, Rui Zhao, Xiaozan Chang, Qiang Li, Yibin Fang, Bo Hong, Yi Xu, Qinghai Huang & Jianmin Liu

Authors
  1. Chuanchuan Wang
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  2. Rui Zhao
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  3. Xiaozan Chang
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  4. Qiang Li
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  5. Yibin Fang
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  6. Bo Hong
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  7. Yi Xu
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  8. Qinghai Huang
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  9. Jianmin Liu
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Correspondence to Jianmin Liu.

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The authors declare that they have no conflict of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wang, C., Zhao, R., Chang, X. et al. Feasibility and midterm outcomes of endovascular embolization for true posterior communicating artery aneurysms. Neuroradiology 61, 1191–1198 (2019). https://doi.org/10.1007/s00234-019-02277-y

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  • DOI: https://doi.org/10.1007/s00234-019-02277-y

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