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Baek, Seung, and Jeong: Distal Posterior Cerebral Artery Aneurysms: Retrospective Review of Characteristics and Endovascular Treatment
Head and Neck Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 74(4): 230-235.

Published online: 25 March 2016

DOI: https://doi.org/10.3348/jksr.2016.74.4.230

Distal Posterior Cerebral Artery Aneurysms: Retrospective Review of Characteristics and Endovascular Treatment

Jin Wook Baek, MD1, 2, Won-Bae Seung, MD3, Hae Woong Jeong, MD2

1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.

3Department of Neurosurgery, Kosin University College of Medicine, Gospel Hospital, Busan, Korea.

Corresponding author: Hae Woong Jeong, MD. Department of Diagnostic Radiology, Inje University College of Medicine, Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel. 82-51-890-6547, Fax. 82-51-896-1085, hwjeong2000@lycos.co.kr

Received 27 July 2015       Revised 26 October 2015       Accepted 26 November 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Aneurysm, Posterior Cerebral Artery, Endovascular Techniques

Figures and Tables

Fig. 1

Successful embolization was done by using parent artery occlusion technique in a 59-year-old female who presented with subarachnoid and intraventricular hemorrhage (patient number 10 in Table 1).

A. Initial non-contrast enhanced computed tomography scan shows diffuse subarachnoid hemorrhage with bilateral intraventricular hemorrhage.
B, C. The anteroposterior (B) and lateral (C) projection views of a left vertebral artery angiography show a fusiform dissecting aneurysm (arrow) with ruptured state in the left P3 segment.
D. Parent artery occlusion (arrow) technique was used for complete embolization.
jksr-74-230-g001
Fig. 2

A saccular dissecting aneurysm at the right P2 segment in a 61-year-old female patient who presented with headache (patient number 3 in Table 1).

A. The anteroposterior projection of right vertebral artery angiography shows a saccular dissecting aneurysm (arrow) in the right P2 segment.
B. After selective coil embolization, complete aneurysmal occlusion (arrow) was conducted without parent artery occlusion.
jksr-74-230-g002
Table 1

Data for Distal PCA Aneurysm in 11 Patients

jksr-74-230-i001
Patient Number Sex/Age (yr) Clinical Presentation Aneurysm Clinical Outcome
Location Type Size (mm) Treatment
1 M/56 SAH P2 Saccular 7 SCE mRS 0
2 F/56 ICH P3 Saccular 8 SCE mRS 0
3 F/61 Hemorrhage (-) P2 Saccular with dissecting 9 SCE mRS 0
4 F/65 Hemorrhage (-) P3 Saccular 3 SCE mRS 0
5 F/49 Hemorrhage (-) P2 Saccular 7 SCE mRS 0
6 F/65 Hemorrhage (-) P1-P2 Saccular 9 SCE mRS 0
7 M/44 ICH P3 Saccular 5 SCE Death
8 F/51 SAH P3 Dissecting 30 PAO mRS 0
9 M/45 SAH P2 Dissecting 5 PAO mRS 0
10 F/59 SAH, IVH P3 Dissecting 7 PAO mRS 4
11 F/72 SAH, IVH P3 Dissecting 3 PAO Death

ICH = intracranial hemorrhage, IVH = intraventricular hemorrhage, mRS = modified Rankin score, PAO = parent artery occlusion, PCA = posterior cerebral artery, SAH = subarachnoid hemorrhage, SCE = selective coil embolization

Table 2

Data for Used Technique and Materials for 11 Patients

jksr-74-230-i002
Patient Number Used Technique Number of Coils Total Coil Length (cm) Procedural Time (min)
1 Balloon assisted 7 93 230
2 Single microcatheter 9 27 160
3 Single microcatheter 12 128 170
4 Single microcatheter 2 5 215
5 Single microcatheter 5 22 80
6 Double microcatheter 21 238 200
7 Single microcatheter 4 20 130
8 Double microcatheter 5 60 120
9 Single microcatheter 5 40 185
10 Single microcatheter 6 23 280
11 Single microcatheter 2 6 135

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