- Department of Neurosurgery, “12 de Octubre” University Hospital, Complutense University of Madrid, Madrid, Spain
- Division of Neuroradiology, “12 de Octubre” University Hospital, Complutense University of Madrid, Madrid, Spain
Pablo M. Munarriz
Department of Neurosurgery, “12 de Octubre” University Hospital, Complutense University of Madrid, Madrid, Spain
DOI:10.4103/2152-7806.143273Copyright: © 2014 Munariz PM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Munarriz PM, Ana M. Castaño-Leon, Cepeda S, Campollo J, Jose F. Alén, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 30-Oct-2014;5:
How to cite this URL: Munarriz PM, Ana M. Castaño-Leon, Cepeda S, Campollo J, Jose F. Alén, Lagares A. Endovascular treatment of a true posterior communicating artery aneurysm. Surg Neurol Int 30-Oct-2014;5:. Available from: http://sni.wpengine.com/surgicalint_articles/endovascular-treatment-true-posterior-communicating-artery-aneurysm/
Background:Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. “True” PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available.
Case Description:A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely.
Conclusion:Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.
Keywords: Cerebral aneurysm, endovascular coiling, posterior communicating artery aneurysm, true posterior communicating artery aneurysm
Posterior communicating artery (PCoA) aneurysm is one of the most frequent types of intracranial aneurysm, accounting for approximately 25% of all intracranial aneurysms.[
A 53-year-old, right-handed male patient presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery (MCA) stroke was diagnosed. The patient's medical history included systemic hypertension and dyslipidemia. Previously undiagnosed atrial fibrillation was then identified. Systemic fibrinolytic therapy was administered first without result; local intraarterial fibrinolytic treatment and mechanical thrombectomy were then performed, achieving recanalization of the distal MCA.
Computed tomography angiography (CTA) that was performed during the diagnosis of the stroke also revealed an aneurysm of the PCoA [
Magnetic resonance imaging (MRI). Axial T2-weighted image (a) showing a mass in the interpeduncular fossa measuring 14 mm in diameter, which is compatible with a thrombosed aneurysm. A gadolinium-enhanced sagittal T1-weighted sequence (b) reveals slight enhancement at the wall of the aneurysm
Bilateral carotid and left vertebral angiography [Figures
Anteroposterior (a) and lateral (b) views with digital subtraction angiography (DSA). The aneurysm is occulted by the supraclinoid portion of the internal carotid artery in the anteroposterior projection. In the lateral view, the aneurysm arises from the posterior communicating artery itself (arrow) and is attached to neither the internal carotid artery nor the posterior cerebral artery. The aneurysm measures 3.5 mm in dome height and 1.5 mm in neck width and originates 3 mm distal to the junction
At the 6-month follow-up, magnetic resonance angiography (MRA) did not show recanalization. The patient exhibited marked neurological improvement with therapy, presenting with mild right hemiparesis and motor dysphasia with mild nonfluent speech and normal comprehension.
Aneurysms originating directly from the PCoA are very unusual. Postmortem observations made by Dandy indicated that aneurysms that were interpreted as PCoA aneurysms based on their angiographical appearance were actually aneurysms of the ICA.[
Although the mechanisms by which aneurysms originate, grow and rupture remain controversial, evidence indicates that hemodynamic factors play a significant role.[
Microsurgical clipping for treating these aneurysms has traditionally been performed.[
In a recent meta-analysis, He et al.[
The complex anatomy of true PCoA aneurysms with successive sharp branch angles within a short distance may preclude safe endovascular access.[
Aneurysms originating directly from the PCoA are rarely encountered. Most previously reported cases were treated surgically, and reported cases of endovascular treatment are scant.
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