Interventional Neuroradiology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Interv Neuroradiol. 2021 Oct;27(5):631-637. doi: 10.1177/15910199211001702. Epub 2021 Mar 5.
Aneurysm formation after internal carotid artery (ICA) occlusion has been described in animal models and human case series with alteration of cerebral blood flow dynamics considered an aetiological risk factor. Such de novo aneurysms have seldom been described in the posterior cerebral artery (PCA) with the majority observed in the anterior circulation collateral pathways.
We retrospectively reviewed our institutional database of posterior circulation aneurysms in patients with iatrogenic, atherosclerotic or congenital ICA occlusions. A comprehensive review of the online literature using the PubMed and Medline databases was performed to identify previous cases of PCA aneurysms that were considered 'flow-related'.
We present five patients with symptomatic or ruptured PCA aneurysms with ICA occlusions. Age at presentation ranged from 21-58 and aneurysm size from 3-12 mm. All cases had angiographic evidence of posterior-anterior flow via the ipsilateral posterior communicating artery (PComA). The clinical presentation, diagnostic imaging and management strategies are further discussed. A literature review identified only two previous reported cases.
To our knowledge this is the first single centre series of posterior circulation aneurysms in patients with ICA occlusions that are considered to be 'flow-related.' The natural history of these rare lesions is unclear and the best management and surveillance strategy requires a patient-tailored approach by an experienced neurovascular team.
在动物模型和人类病例系列中，已经描述了颈内动脉（ICA）闭塞后的动脉瘤形成，而脑血流动力学的改变被认为是一个致病危险因素。在大脑后动脉（PCA）中，这种新形成的动脉瘤很少见，大多数发生在前循环侧支途径中。
我们回顾性地审查了我们机构数据库中因医源性、动脉粥样硬化或先天性 ICA 闭塞而导致的后循环动脉瘤患者。我们使用 PubMed 和 Medline 数据库对在线文献进行了全面综述，以确定先前被认为是“血流相关性”的 PCA 动脉瘤病例。
我们提出了 5 例 ICA 闭塞伴症状性或破裂性 PCA 动脉瘤患者。发病年龄为 21-58 岁，动脉瘤大小为 3-12mm。所有病例均有同侧后交通动脉（PComA）后前血流的血管造影证据。进一步讨论了临床表现、诊断影像学和治疗策略。文献复习仅发现了两例先前报道的病例。
据我们所知，这是首个关于 ICA 闭塞患者的后循环动脉瘤的单中心系列研究，这些动脉瘤被认为是“血流相关性”的。这些罕见病变的自然史尚不清楚，最佳的治疗和监测策略需要由经验丰富的神经血管团队为每个患者量身定制。
