Division of Neurointerventional Radi-ology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Department of Radiology, University of Iowa, Iowa City, Iowa.
Neurosurgery. 2018 Oct 1;83(4):790-799. doi: 10.1093/neuros/nyx561.
Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage.
To examine the safety and effectiveness of PCA aneurysm flow diverter treatment.
Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared.
Ten PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. Complete aneurysm occlusion with parent vessel preservation was achieved in 75% (6/8) of cases at mean follow-up of 16.7 mo. Eleven of 12 (92%) major branch vessels covered by a PED remained patent. Including the present study, systematic review of 15 studies found a complete aneurysm occlusion rate of 88% (30/34) and complication rate of 26% (10/38), including 5 symptomatic ischemic strokes (13%; 5/38). Fusiform aneurysms more frequently completely occluded compared with saccular aneurysms (100% vs 70%; P = .03) but were associated with a higher complication rate (43% vs 9%; P = .06).
The safety and effectiveness profile of flow diverter treatment of PCA aneurysms may be acceptable in select cases.
由于对载瘤动脉大小和分支血管覆盖的担忧，后交通动脉（PCA）动脉瘤的血流导向治疗尚未得到广泛报道。
评估 PCA 动脉瘤血流导向装置（PED；美敦力公司，都柏林，爱尔兰）治疗的安全性和有效性。
对 3 个神经血管中心的 10 例 PCA 动脉瘤患者（9 例）行 PED 治疗，回顾性分析其围手术期并发症和临床及血管造影结果。系统检索文献，识别并汇总了已发表的采用血流导向装置治疗 PCA 动脉瘤的病例报告。计算动脉瘤闭塞率和并发症发生率，并比较囊状和梭形动脉瘤的治疗效果。
10 例患者共 10 个 PCA 动脉瘤接受了 PED 治疗。术中发生 2 例（20%）血栓栓塞事件，包括 1 例症状性脑梗死和 1 例迟发性 PED 血栓形成。8 例患者的基线功能状态恢复或改善。75%（6/8）的患者在平均 16.7 个月的随访时获得了完全动脉瘤闭塞和载瘤动脉保留。12 支被 PED 覆盖的主要分支血管中有 11 支（92%）保持通畅。包括本研究在内，系统综述 15 项研究发现完全闭塞率为 88%（30/34），并发症发生率为 26%（10/38），包括 5 例症状性缺血性卒中（13%；5/38）。梭形动脉瘤的完全闭塞率明显高于囊状动脉瘤（100%比 70%；P=.03），但并发症发生率也更高（43%比 9%；P=.06）。
对于特定病例，PED 治疗 PCA 动脉瘤的安全性和有效性可能是可以接受的。
