Dissecting aneurysms of the distal segment of the posterior cerebral artery: Clinical presentation and endovascular management

被引：4
作者：
Qian Z. [1 ,2 ]
Feng X. [1 ,2 ]
Kang H. [1 ,2 ]
Wen X. [1 ,2 ]
Xu W. [1 ,2 ]
Li Y. [1 ,2 ]
Jiang C. [1 ,2 ]
Wu Z. [1 ,2 ]
Liu A. [1 ,2 ]
机构：
[1] Beijing Neurosurgical Institute, Capital Medical University, Beijing
[2] Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing
来源：
Chinese Neurosurgical Journal | / 3卷 / 1期
基金：
中国国家自然科学基金;
关键词：
Dissecting aneurysm; Embolization; Occlusion; Posterior cerebral artery;
D O I：
10.1186/s41016-016-0066-z
中图分类号：
学科分类号：
摘要：
Backgroud: We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO). Methods: From June 2006 to July 2013, 26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution. Fourteen patients had ruptured aneurysms, and twelve patients had unruptured aneurysms. The endovascular modalities were the following: 1) PAO (n = 19), 2) palliative embolization (n = 5), and 3) proximal PAO (n = 2). Glasgow Outcome Scale (GOS) was used to assess the clinical outcome. Results: The procedure was technically successful in all cases. In the PAO and proximal PAO group, all of the immediate angiography showed occlusion of the parent vessel, and follow-up imaging showed no recurrence of the aneurysms. In the palliative embolization group, one of five patients was died of rebleeding after the procedure, and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred. Five procedure related complications occurred totally: rebleeding (n = 1), hemiparesis (n = 2), and hemianopsia (n = 2). Conclusion: Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted. Sacrificing the parent artery appears to be well tolerated for distal segment of PCA. We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location. However, palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option. © 2017 The Author(s).
引用
收藏
相关论文
共 25 条
  • [1] Lv X., Li Y., Jiang C., Yang X., Wu Z., Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery, Surg Neurol, 71, 3, pp. 319-325, (2009)
  • [2] Clcd S., Gmd W., Pepa G.E., Calabro A., Albanese D'Argento F., Fernandez E., Olivi A., Puca A., Pedicelli A., Marchese E., Endovascular Treatment of the Posterior Cerebral Artery Aneurysms: Single-Center Experience and a Systematic Review, World Neurosurgery, (2016)
  • [3] Zumofen D.W., Shapiro M., Becske T., Raz E., Potts M.B., Riina H.A., Nelson P.K., Endoluminal reconstruction for nonsaccular aneurysms of the proximal posterior cerebral artery with the pipeline embolization device, AJNR Am J Neuroradiol, 36, pp. 1299-1302, (2015)
  • [4] Terasaka S., Sawamura Y., Kamiyama H., Fukushima T., Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery, Neurosurgery, 47, pp. 359-364, (2000)
  • [5] Wang Y., Lou X., Li Y., Et al., Imaging investigation of intracranial arterial dissecting aneurysms by using 3 T high-resolution MRI and DSA: From the interventional neuroradiologists' view, Acta Neurochir (Wien), 156, pp. 515-525, (2014)
  • [6] Wakhloo A.K., Mandell J., Gounis M.J., Et al., Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: Long-term clinical and angiographic follow-up, Stroke, 39, pp. 3288-3296, (2008)
  • [7] Liu L., He H., Jiang C., Lv X., Li Y., Deliberate parent artery occlusion for non-saccular posterior cerebral artery aneurysms, Interv Neuroradiol, 17, pp. 159-168, (2011)
  • [8] Hamada J., Morioka M., Yano S., Todaka T., Kai Y., Kuratsu J., Clinical features of aneurysms of the posterior cerebral artery: A 15-year experience with 21 cases, Neurosurgery, 56, pp. 662-670, (2005)
  • [9] Goehre F., Jahromi B.R., Hernesniemi J., Elsharkawy A., Kivisaari R., Et al., Characteristics of posterior cerebral artery aneurysms: An angiographic analysis of 93 aneurysms in 81 patients, Neurosurgery, 75, pp. 134-144, (2014)
  • [10] Ferrante L., Acqui M., Trillo G., Lunardi P., Fortuna A., Aneurysms of the posterior cerebral artery: Do they present specific characteristics?, Acta Neurochir (Wien), 138, pp. 840-852, (1996)
123