Cho Y D, Jung S C, Kim C H, Ahn J H, Kang H-S, Kim J E, Han M H
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clin Neuroradiol. 2015 Sep;25(3):275-9. doi: 10.1007/s00062-014-0308-4. Epub 2014 May 3.
Whether the posterior communicating artery (PcomA) can be safely compromised during endovascular treatment of a PcomA aneurysm is a matter of debate. Here we present clinical and radiologic outcomes, given this scenario.
From data prospectively accrued between January 2004 and December 2012, records of 44 patients harboring 46 PcomA aneurysms were retrieved. All had suffered PcomA compromise in the course of endovascular coil embolization. Patients/aneurysms were stratified into those with complete (Group A) and incomplete (Group B) compromise depending on the degree of PcomA flow limitation documented by postembolization ipsilateral internal carotid artery angiography. Clinical and radiologic outcomes were accordingly assessed.
All affected vessels were hypoplastic PcomA variants (PcomA/P1 ratio, ≤ 1.0), with exception of a single dominant PcomA (PcomA/P1 ratio, 1.1). In Group A (23 patients, 23 aneurysms), no PcomA compromise-related infarction was evident, whereas in Group B (21 patients, 23 aneurysms), two ischemic events occurred. One patient suffered thalamic infarction, although patency of the PcomA was adequate in a follow-up angiogram, and another experienced a transient ischemic attack.
Our findings suggest that obstructed flow in hypoplastic PcomA variants during coil embolization of PcomA aneurysms carries no major consequence. However, incomplete compromise of the PcomA may be a source of delayed thromboembolic infarction.
在后交通动脉瘤的血管内治疗过程中，后交通动脉（PcomA）是否能够安全地受到损伤仍存在争议。在此，我们呈现了在这种情况下的临床和影像学结果。
从2004年1月至2012年12月前瞻性收集的数据中，检索出44例患有46个后交通动脉瘤患者的记录。所有患者在血管内弹簧圈栓塞过程中均出现了后交通动脉损伤。根据栓塞后同侧颈内动脉血管造影记录的后交通动脉血流受限程度，将患者/动脉瘤分为完全损伤组（A组）和不完全损伤组（B组）。相应地评估临床和影像学结果。
除1例优势后交通动脉（后交通动脉/颈内动脉海绵窦段比值为1.1）外，所有受累血管均为发育不良的后交通动脉变异型（后交通动脉/颈内动脉海绵窦段比值≤1.0）。在A组（23例患者，23个动脉瘤）中，未发现与后交通动脉损伤相关的梗死，而在B组（21例患者，23个动脉瘤）中，发生了2次缺血事件。1例患者发生丘脑梗死，尽管随访血管造影显示后交通动脉通畅，另1例经历了短暂性脑缺血发作。
我们的研究结果表明，在后交通动脉瘤弹簧圈栓塞过程中，发育不良的后交通动脉变异型血流受阻不会产生重大后果。然而，后交通动脉的不完全损伤可能是延迟性血栓栓塞性梗死的一个来源。
