Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms

Clinical article

Restricted access

Object

The purpose of this study was to report the potential proneness of a fetal-type posterior cerebral artery (PCA) to develop vascular insufficiency in parent vessel occlusion of distal PCA aneurysms.

Methods

Between January 2005 and January 2011, 19 patients (9 females and 10 males) with 20 distal PCA aneurysms (16 dissecting and 4 saccular) were treated with endovascular parent vessel occlusion. The ages of the patients ranged from 5 to 71 years, with a mean age of 40.2 years. Of the 20 aneurysms, 4 were ruptured and 16 were unruptured. One of the unruptured aneurysms was additional to another ruptured aneurysm, and 15 were incidentally discovered. Five aneurysms were smaller than 10 mm, and the other 15 were 10 mm or larger.

Results

All aneurysms were successfully treated with simultaneous coil occlusion of the aneurysm and the parent PCA. One patient had hemianopia at the initial presentation, and 2 patients had new persistent hemianopia due to insufficient leptomeningeal collateral circulation; in 16 patients with an intact visual field, no hemianopia developed because there was sufficient leptomeningeal collateral circulation. A fetal-type PCA was involved in all 3 patients with hemianopia, which was initially presented or caused by parent vessel occlusion. However, in the patients without hemianopia, an adult-type PCA was involved in all cases.

Conclusions

Endovascular treatment via coil occlusion of the aneurysm as well as the parent artery can be used to cure distal PCA aneurysms. A fetal-type PCA could be an important predictive factor for vascular insufficiency in parent vessel occlusion treatment.

Abbreviations used in this paper:ICA = internal carotid artery; PCA = posterior cerebral artery.

Article Information

Address correspondence to: Zhongxue Wu, M.D., Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing 100050, People's Republic of China. email: ttyyzjb@sina.com.

Please include this information when citing this paper: published online May 18, 2012; DOI: 10.3171/2012.4.JNS111788.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Images obtained in a patient with an adult-type PCA who tolerated parent vessel occlusion well. Axial T1-weighted MR image (A) showing a giant dissecting aneurysm of the P2 segments of the right PCA. Angiogram (B), left vertebral artery injection, showing a dissecting aneurysm arising from the right P2 segment. Angiograms, frontal view with left vertebral artery injection (C), obtained after embolization, and lateral view with right ICA injection (D), showing occlusion of the P2 segment aneurysm and the PCA, with distal perfusion via leptomeningeal anastomoses. The patient had a good outcome.

  • View in gallery

    Parent vessel occlusion complicated by cerebral infarction in the distal arterial territory in a patient with a fetal-type PCA. Three-dimensional reconstruction (A), left ICA injection, demonstrating a large dissecting aneurysm of the left P2 segment. Angiogram (B), lateral view with left ICA injection obtained after embolization, showing occlusion of the aneurysm and the P2 segment. Note that there was no retrograde flow from the cortical branches of the ipsilateral middle cerebral artery. Homonymous hemianopia complicated the treatment. Posttreatment CT scans (C) showing an acute infarction in the distribution of the left PCA territory.

References

  • 1

    Arat AIslak CSaatci IKocer NCekirge S: Endovascular parent artery occlusion in large-giant or fusiform distal posterior cerebral artery aneurysms. Neuroradiology 44:7007052002

    • Search Google Scholar
    • Export Citation
  • 2

    Brozici Mvan der Zwan AHillen B: Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke 34:275027622003

  • 3

    Ciceri EFKlucznik RPGrossman RGRose JEMawad ME: Aneurysms of the posterior cerebral artery: classification and endovascular treatment. AJNR Am J Neuroradiol 22:27342001

    • Search Google Scholar
    • Export Citation
  • 4

    Ferrante LAcqui MTrillò GLunardi PFortuna A: Aneurysms of the posterior cerebral artery: do they present specific characteristics?. Acta Neurochir (Wien) 138:8408521996

    • Search Google Scholar
    • Export Citation
  • 5

    Hallacq PPiotin MMoret J: Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: retrospective review of a 10-year series. AJNR Am J Neuroradiol 23:112811362002

    • Search Google Scholar
    • Export Citation
  • 6

    Hendrikse Jvan Raamt AFvan der Graaf YMali WPvan der Grond J: Distribution of cerebral blood flow in the circle of Willis. Radiology 235:1841892005

    • Search Google Scholar
    • Export Citation
  • 7

    Honda MTsutsumi KYokoyama HYonekura MNagata I: Aneurysms of the posterior cerebral artery: retrospective review of surgical treatment. Neurol Med Chir (Tokyo) 44:1641692004

    • Search Google Scholar
    • Export Citation
  • 8

    Lee JYKwon BJKang HSWang KC: Subarachnoid hemorrhage from a dissecting aneurysm of the posterior cerebral artery in a child: rebleeding after stent-assisted coiling followed by stent-within-stent technique. J Korean Neurosurg Soc 49:1341382011

    • Search Google Scholar
    • Export Citation
  • 9

    Lv XLi YJiang CYang XWu Z: Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery. Surg Neurol 71:3193252009

    • Search Google Scholar
    • Export Citation
  • 10

    Roh HGKim SSHan HKang HSMoon WJByun HS: Endovascular treatment of posterior cerebral artery aneurysms using detachable coils. Neuroradiology 50:2372422008

    • Search Google Scholar
    • Export Citation
  • 11

    Taylor CLKopitnik TA JrSamson DSPurdy PD: Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg 99:15222003

    • Search Google Scholar
    • Export Citation
  • 12

    Terasaka SSawamura YKamiyama HFukushima T: Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47:3593662000

    • Search Google Scholar
    • Export Citation
  • 13

    van Raamt AFMali WPvan Laar PJvan der Graaf Y: The fetal variant of the circle of Willis and its influence on the cerebral collateral circulation. Cerebrovasc Dis 22:2172242006

    • Search Google Scholar
    • Export Citation
  • 14

    Yoon SMBae HGYun IGShim JJDoh JWLee KS: Is stent-assisted coiling effective for the treatment of dissecting aneurysm?. Presented at the 6th East Asian Conference of NeurointerventionShanghai, ChinaSeptember 8–11, 2011(Abstract)

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 130 130 13
Full Text Views 99 99 0
PDF Downloads 162 162 0
EPUB Downloads 0 0 0

PubMed

Google Scholar