Abstract
Although several innovations in techniques and implantable devices were reported over the last decades, a consensus on the best endovascular treatment for intracranial aneurysms originating from the posterior communicating artery is still missing. This work investigates radiological outcomes of different endovascular techniques for posterior communicating artery aneurysms treatment in a retrospective multi-centric cohort. We included patients endovascularly treated for posterior communicating artery aneurysms from 2015 through 2020 in six tertiary referral hospitals. We evaluated the relationship between patients and aneurysms characteristics, baseline neurological status, radiological outcomes, and the different endovascular techniques. Overall, 250 patients were included in this study. Simple coiling was the most frequent treatment in 171 patients (68%), followed by flow-diverter stenting in 32 cases (13%). Complete occlusion was reported in 163 patients (65%), near-complete occlusion in 43 (17%), and incomplete occlusion in 44 (18%). Radiological follow-up was available for 247 (98%) patients. The occlusion rate was stable in 149 (60%), improved in 49 (19%), and worsened in 51 (21%). No significant difference in exclusion rate was seen between ruptured and unruptured aneurysms at the last follow-up (p = 0.4). Posterior communicating artery thrombosis was reported in 25 patients (9%), transient ischemic attack in 6 (2%), and in 38 patients (15%), subsequent procedures were needed due to incomplete occlusion or reperfusion. Endovascular strategies for posterior communicating artery aneurysms represent effective and relatively safe treatments. Simple coiling provides a higher immediate occlusion rate, although recanalization has been frequently reported, conversely, flow-diversion devices provide good long-term radiological outcomes.
Highlights
Posterior communicating artery (PComA) is about 25% of all intracranial aneurysms and 50% of internal carotid artery (ICA) aneurysms, representing one of the most common vascular malformations encountered by neurosurgeons and neurointerventional radiologists [1]
Surgical or hybrid treatments of PComA aneurysms are quite common [3,4,5,6,7,8,9,10,11], but few studies focus on the long-term outcome of large cohorts undergoing endovascular treatment
We collected for each patient: (1) demographics: age, gender; (2) neurological status at admission; (3) complications; (4) radiological outcome measured as presence or absence of subarachnoid hemorrhage; aneurysm size and morphology; neck width; fetal-type PComA; treatment type; occlusion rate at post-operative imaging and follow-up (6– 12–24 months); need for second re-treatments
Summary
Posterior communicating artery (PComA) is about 25% of all intracranial aneurysms and 50% of internal carotid artery (ICA) aneurysms, representing one of the most common vascular malformations encountered by neurosurgeons and neurointerventional radiologists [1]. Several anatomical variants of PComA aneurysms may have technical implications for their treatment, especially size, PComA fetal variant (4–29% of cases) [2], and relationship of the PComA origin and aneurysm neck [3]. The recent advent of flow diverters and other newly designed endovascular devices has improved the feasibility and outcomes of PComA aneurysms. Their longterm efficacy remains debated in particular cases, such as when associated with fetal-type PComA [12,13,14,15,16,17]. We retrospectively collected a large multicenter series of patients treated for PComA aneurysms with different endovascular techniques. Data about angioarchitecture features and related radiological outcomes and complications were analyzed according to the different endovascular techniques adopted. This paper is mainly focused on the pure radiological technical aspect
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
