Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms.

Abstract

To evaluate the safety and long-term efficacy of stent-assisted coiling for the treatment of complex posterior cerebral artery (PCA) aneurysms. Angiographic and clinical data of 23patients harboring 23complex PCA aneurysms treated with stent-assisted coiling from March 2010 to March 2017 were retrospectively reviewed. In this study 8 (34.8%) aneurysms were located at the P1segment, 7 (30.4%) at the junction of P1 and P2segments (P1-2), and 8 (34.8%) at the P2segment. The aneurysms were ruptured in 7cases (30.4%). Thirteen were dissecting in nature, while the other 10 were classical saccular aneurysms. Of the patients, 5 (21.7%) had of history of recent head trauma, immediate angiographic results were Raymond classI in 5 (21.7%) cases, Raymond classII in 8 (34.8%), and Raymond classIII in 10 (43.5%). Perioperative complications occurred in one case with occlusion of the PA due to acute in-stent thrombosis without any neurologic deficit at discharge. The last angiographic follow-up (mean 18.7months) results demonstrated complete aneurysmal occlusion in 20 (87.0%) cases, PA occlusion in 1 (4.3%) and recurrence in 2 (8.7%). Of the two patients with aneurysm recurrence, one was treated by PA occlusion, and the other was treated with two overlapping stents. Clinical follow-up (mean 58.3months) was available for all 23patients, 22 (95.7%) patients had good neurologic outcomes (mRS score 0-2), and 1 (4.3%) patient died 7months after the procedure for unknown reasons. Stent-assisted coiling for the treatment of complex PCA aneurysms is safe and durable with arelatively low rate of complication and arelatively high rate of complete occlusion at long-term follow-up and is apromising alternative strategy for the reconstruction of the PCA.