Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Neurointerv Surg. 2019 Apr;11(4):373-379. doi: 10.1136/neurintsurg-2018-014233. Epub 2018 Oct 5.
Posterior communicating artery (PcoA) compromise may serve as adjunctive treatment in patients with hypoplastic variants of PcoA who undergo coil embolization of PcoA aneurysms. However, procedural safety and the propensity for later recanalization are still unclear.
To evaluate clinical and radiologic outcomes of coil embolization in this setting, focusing on compromise of PcoA.
As a retrospective review, we examined 250 patients harboring 291 aneurysms of hypoplastic PcoAs, all consecutively treated by coil embolization between January 2004 and June 2016. PcoA compromise was undertaken in conjunction with 81 of the treated aneurysms (27.8%; incomplete 53; complete 28). Medical records and radiologic data were assessed during extended monitoring.
During the mean follow-up of 33.9±24.6 months (median 36 months), a total of 107 (36.8%) coiled aneurysms showed recanalization (minor 50; major 57). Recanalization rates were as follows: PcoA preservation 40.5% (85/210); incomplete PcoA occlusion 34.0% (18/53); complete PcoA occlusion 14.3% (4/28). Aneurysms >7 mm (HR 3.40; P<0.01), retreatment for recanalization (HR 3.23; P<0.01), and compromise of PcoA (P<0.01) emerged from multivariate analysis as significant risk factors for recanalization. Compared with PcoA preservation, complete PcoA compromise conferred more favorable outcomes (HR 0.160), whereas incomplete compromise of PcoA fell short of statistical significance. Thromboembolic infarction related to PcoA compromise did not occur in any patient.
PcoA compromise in conjunction with coil embolization of PcoA aneurysms appears safe in hypoplastic variants of PcoA, helping to prevent recanalization if complete occlusion is achieved.
在后交通动脉（PcoA）代偿不全的情况下，对接受后交通动脉瘤线圈栓塞的 PcoA 发育不全变异患者进行辅助治疗。然而，程序安全性和再通倾向尚不清楚。
评估在此背景下线圈栓塞的临床和影像学结果，重点关注 PcoA 代偿不全。
作为回顾性研究，我们检查了 2004 年 1 月至 2016 年 6 月期间连续接受线圈栓塞治疗的 250 例患有 PcoA 发育不全的 291 个动脉瘤患者。在治疗的 81 个动脉瘤中（27.8%；不完全闭塞 53 个；完全闭塞 28 个）进行了 PcoA 代偿不全。在延长监测期间评估病历和影像学数据。
在平均 33.9±24.6 个月（中位数 36 个月）的随访期间，共有 107 个（36.8%）线圈栓塞的动脉瘤发生再通（小的 50 个；大的 57 个）。再通率如下：PcoA 保留 40.5%（210/520）；不完全 PcoA 闭塞 34.0%（53/156）；完全 PcoA 闭塞 14.3%（28/199）。多变量分析显示，动脉瘤>7mm（HR 3.40；P<0.01）、再通治疗（HR 3.23；P<0.01）和 PcoA 代偿不全（P<0.01）是再通的显著危险因素。与 PcoA 保留相比，完全 PcoA 代偿不全的结果更有利（HR 0.160），而不完全 PcoA 代偿不全则没有统计学意义。与 PcoA 代偿不全相关的血栓栓塞性梗死在任何患者中均未发生。
在后交通动脉瘤线圈栓塞中，在后交通动脉代偿不全的情况下，在 PcoA 发育不全的情况下似乎是安全的，如果实现完全闭塞，可以帮助预防再通。
