Clinical features and endovascular therapy of posterior cerebral artery aneurysms: a report of 17 cases

Abstract

Objective To investigate the clinical features, endovascular embolization therapy, and treatment outcome of posterior cerebral artery aneurysms. Methods The clinical features, treatment and prognosis of 17 patients with posterior cerebral artery aneurysms embolized endovascularly at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2009 to March 2015 were analyzed retrospectively. A total of 18 aneurysms were in 17 cases, 11 (61%) of them were saccular aneurysms, 7 (39%) were fusiform or dissecting aneurysms. Four aneurysms were located in the posterior cerebral artery P1 segment, 1 in P1 and P2 junction zone, 9 in P2 segment, and 4 in P3 segment and beyond. Eight aneurysms were treated with intracapsular coil embolization only, retaining the parent arteries, 6 aneurysms were treated with coil embolization and the parent arteries were occluded at the same time, 1 aneurysm was implanted stents, 1 aneurysm was treated with ballon-assisted embolization, and 2 were not treated.The modified Rankin scale(mRS) was used to evaluate the prognosis. The follow up time ranged from 1 to 5 years. Results In the 18 aneurysms, immediate angiography after aneurysm surgery showed that the treated 15 aneurysms were totally embolized. No cerebral ischemia occurred in 6 patients treated with parent artery embolization. One patient with cerebral arteriovenous malformation occurred rebleeding after procedure and left neurological dysfunction after symptomatic treatment, other patients did not have intervention-related complications and the symptom of neurological deficit. In 17 patients with posterior cerebral artery aneurysms, 16 patients completed follow-up and 1 patient lost to follow up.No recurrence in the 14 treated aneurysms have been demonstrated in the DSA reviews during the follow-up period.The mRS 0 was in 12 cases, 1 in 2 cases, 2 in 3 cases. Conclusions The posterior cerebral artery aneurysms are often located in P2 segments. Dissecting or fusiform aneurysms are more common than other types. According to the characteristics of aneurysms, the appropriate endovascular embolization scheme can be selected. The treatment process is safe and reliable, and the satisfactory efficacy can be obtained. Key words: Intracranial aneurysm; Posterior cerebral artery; Endovascular procedures; Treatment outcome