E-124 angiographic characteristics and treatment strategies of posterior communicating artery aneurysm

Abstract

Instruction In cases of posterior communicating artery (PcomA) aneurysm, the relationship between complication and obstruction of PcomA has been poorly understood. We report ischemic complications related to the obstruction of PcomA and suggest the strategies of treatment according to the angiographic characteristics of PcomA and Posterior cerebral artery (PCA). Materials and methods Clinical and radiological records of 166 cases of coil embolization treated for a PcomA aneurysm during 11 years were retrospectively reviewed. Twenty one patients with PcomA aneurysm who had initially undergone endovascular treatment and had been identified the occlusion of PcomA on immediate or follow-up angiography were enrolled. We classified PcomA aneurysm according to the characteristics PcomA and PCA (P1) in baseline angiography as followed; Type I was defined as PcomA aneurysm with an absent PcomA and a normal sized P1. Type II was defined as a hypoplastic PcomA and a normal sized P1. Type III was defined as a normal sized PcomA and an absent P1. Type IV was defined as a normal sized PcomA and a hypoplastic P1. Type V was a normal sized PcomA and a normal sized P1. Results Among all cases of PcomA obstruction, 15 cases (71.4%) were type II PcomA aneurysm, 4 cases were type IV, one case was type III and one case was type V. The ischemic events related PcomA obstruction occurred in 3 cases (type II, type III and type IV), which were included in 2 tuberothalamic infarctions (type III and type IV) and one cortical infarction in PCA territories (type II). Conclusion In cases of PcomA aneurysm with normal sized PcomA and hypoplastic or absent P1, the surgeon should pay special attention to the obstruction of PcomA and we believe that the size of ipsilateral P1 in baseline angiography might be important factor of ischemic complication related to the obstruction of PcomA. Disclosures J. Ko: None. Y. Kim: None.