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  • Selective compromise of hypoplastic posterior communicating artery variants with aneurysms treatable by coil embolization: clinical and radiologic outcomes

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Hemorrhagic Stroke
Original research
Selective compromise of hypoplastic posterior communicating artery variants with aneurysms treatable by coil embolization: clinical and radiologic outcomes
  1. Hyun Ho Choi1,
  2. Young Dae Cho2,
  3. Dong Hyun Yoo2,
  4. Eung Koo Yeon2,
  5. Jeongjun Lee3,
  6. Su Hwan Lee4,
  7. Hyun-Seung Kang4,
  8. Won-Sang Cho4,
  9. Jeong Eun Kim4,
  10. Moon Hee Han2,4
  1. 1 Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
  2. 2 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  3. 3 Departments of Neurosurgery, Dongguk University College of Medicine, Dongguk University Hospital, Ilsan, Korea
  4. 4 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  1. Correspondence to Dr Young Dae Cho, Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea; aronnn{at}naver.com

Abstract

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 To evaluate clinical and radiologic outcomes of coil embolization in this setting, focusing on compromise of PcoA.

Methods As a retrospective review, we examined 250 patients harboring 291 aneurysms of hypoplastic PcoAs, all consecutively treated 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 the 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); 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.

  • aneurysm
  • coil embolization
  • posterior communicating artery
  • compromise
  • recanalization

https://doi.org/10.1136/neurintsurg-2018-014233

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    Footnotes

    • Contributors HHC conceived and conducted the review of this series, analysed the data, drafted and revised the manuscript, and approved the final version. JL, H-SK, MHH, W-SC, JEK, SHL, EKY, and DHY assisted in conducting the review of the series, performed the operations, revised the manuscript, and approved the final draft. YDC conceived and conducted the project, performed the operations, analysed the data, revised the manuscript, and approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The Seoul National University Hospital, Seoul National University.

    • Provenance and peer review Not commissioned; externally peer reviewed.