Fellow Beth Israel Deaconess Medical Center Boston, Massachusetts, United States
Introduction: Posterior communicating (Pcom) artery aneurysms carry higher rupture risks compared to other locations. Coiling of ruptured Pcom aneurysms can be challenging due to the relationship of the aneurysm neck to the Pcom, especially in cases with a fetal PCA. The efficacy of subtotal aneurysm coiling followed by flow diversion is unclear.
Methods: Aneurysms from two centers initially presenting with rupture or acute oculomotor nerve palsy were included. Data on demographics, SAH severity, aneurysm morphology, angiographic outcomes, and clinical outcomes were recorded.
Results: A total of 13 patients were identified (12 female, average age 51). There was a fetal PCA in 2 patients. The immediate Raymond-Roy (RR) occlusion grade after coiling was 1 in 4 patients, 2 in 4 patients, and 3 in 5 patients. There was one complication after flow diversion, which was an intracerebral hemorrhage resulting in death. Nine patients had angiographic follow up (mean 11.5 months) with 4 of 9 (44%) achieving complete occlusion, 3 achieving RR 2 occlusion and 2 achieving RR 3 occlusion. In 6 patients, the Pcom remained patent at follow up, and in 3 it occluded. All 3 patients with occlusion of the Pcom at follow up achieved complete (RR 1) aneurysm occlusion, versus 1 of 6 in whom the Pcom remained patent (p = 0.018, Chi-squared). The two patients with fetal PCAs achieved RR 2 and RR 3 occlusion respectively.
Conclusion : The rate of complete aneurysm occlusion in this series was 44%, which is lower than expected based on larger series. Occlusion of the Pcom artery was seen in most patients with complete aneurysm occlusion. These findings suggest that flow diversion for previously ruptured and coiled posterior communicating artery aneurysms may carry lower than expected efficacy. Limitations include the small sample size and the average follow up of approximately 1 year.
