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Abstract
Introduction The purpose of this study was to evaluate the clinical presentation, endovascular treatment of aneurysms of the posterior cerebral artery and to compare the outcomes with contemporary Surgical and Endovascular Studies.
Materials and methods A retrospective evaluation of our clinical records over the last 10 years. Patients were initially evaluated clinically followed by cross-sectional imaging. The definitive diagnosis, angioarchitecture, planning and risk stratification was done on a digital subtraction angiography study. Out of a total of 27 patients with 28 aneurysms, the average age was 35.8 years (range: 16–60 years). 11(39%) aneurysms were on right side. Most 10(35.7%) were located on P1segment while 7(25%) were on P2segment. 5(17.8%) were on P1-P2 junctional segment, 4(14.3%) on P2-P3 junction and 2(7.14%) on P4 segments of PCA. Most were 7(25%) were small dissecting type. The rest included completely thrombosed aneurysm (2), bleb blister-like (1), large dissecting (3), partially thrombosed (6), giant (3), saccular (1), serpentine (2) and fusiform (3). Comparison was done with other large scale surgical and endovascular series of PCA aneurysms and the outcomes were compared.
Most of the aneurysms were ruptured with acute bleeds (48.2%) and 8 patients had cranial nerve palsy from mass effect. Third cranial nerve (5 patients) was most commonly involved, followed by sixth cranial nerve (3 patients) palsies. One patient had seventh cranial nerve palsy. Visual abnormalities were present in 8 patients (29%) with cerebral ischemic infarcts in 2 patients (7.4%). Seizures were the presenting feature in a single patient with completely thrombosed aneurysm. The commonest association was internal acrotid artery stenosis or occlusion seen in five patients (21.4%). Procedure related complications were seen in 9 patients (33.3%) with spontaneous cure in three patients. Two patients were managed conservatively.
Results Most of the patients (18) were treated by endovascular coiling. Out of these one underwent balloon test occlusion and one patient underwent balloon-assisted coiling. Intra-luminal coiling was done in three patients, whereas 15 patients were treated by parent vessel occlusion and inside-out coiling. Glue was used in one patient, while one patient was lost to follow-up. All occluded aneurysms were stable on follow up studies done at 6month interval.
Conclusion Aneurysms of the PCA are rare with an incidence of 1% of all aneurysms. Clinical presentation is variable with bleeds, cranial nerve palsies, visual field defects or a combination. Endovascular treatment with either parent vessel occlusion or selective occlusion of the aneurysm with coils is safe and effective with good outcomes.
Disclosures P. Mondel: None. R. Saraf: None. U. Limaye: None.