Background Posterior communicating artery (PcoA) compromise may serve as adjunctive treatment in patients with hypoplastic variants of PcoA who undergo coil embolization of PcoA aneurysms. However, procedural safety and the propensity for later recanalization are still unclear.

Objective Our objective was to evaluate clinical and radiologic outcomes of coil embolization in this setting, focusing on compromise of PcoA.

Methods A retrospective review was performed, examining 250 patients harboring 291 PcoA aneurysms with hypoplastic PcoAs treated consecutively by coil embolization between January 2004 and June 2016. PcoA compromise was undertaken in conjunction with 81 of the treated aneurysms (27.8%; incomplete, 53; complete, 28). Medical records and radiologic data were assessed during extended monitoring.

Results During mean follow-up of 33.9±24.6 months (median, 36 months), a total of 107 (36.8%) coiled aneurysms showed recanalization (minor, 50; major, 57). Recanalization rates were as follows: PcoA preservation, 40.5% (85/210); incomplete PcoA occlusion, 34.0% (18/53); and complete PcoA occlusion, 14.3% (4/28). Aneurysms >7 mm (HR=3.40; p<0.01), retreatment for recanalization (HR=3.23; p<0.01), and compromise of PcoA (p<0.01) emerged from multivariate analysis as significant risk factors for recanalization. Compared with PcoA preservation, complete PcoA compromise conferred more favorable outcomes (HR=0.160), whereas incomplete compromise of PcoA fell short of statistical significance. Thromboembolic infarction related to PcoA compromise did not occur in any patient.

Conclusion PcoA compromise in conjunction with coil embolization of PcoA aneurysms appears safe in hypoplastic variants of PcoA, helping to prevent recanalization if complete occlusion is achieved.

Disclosures Y. Cho: None.