Dissecting aneurysms of the posterior cerebral artery – A retrospective review of imaging, angiographic characteristics, endovascular management and outcome
| Autor: | Chandrajit Prasad, Jitender Saini, Hima Pendharkar, Arvinda Hr, Shumyla Jabeen, Dhaval Shukla, Arun Kumar Gupta |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Posterior cerebral artery 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine.artery Occlusion medicine Humans cardiovascular diseases Retrospective Studies Posterior Cerebral Artery Retrospective review business.industry Endovascular Procedures Intracranial Aneurysm Embolization Therapeutic Aneurysm Cerebral Angiography Dissecting Aneurysms Aortic Dissection Treatment Outcome Balloon test occlusion cardiovascular system Female Radiology business Parent vessel 030217 neurology & neurosurgery |
| Zdroj: | Interv Neuroradiol |
| ISSN: | 2385-2011 1591-0199 |
| DOI: | 10.1177/1591019920967572 |
| Popis: | Purpose To review management, clinical and imaging outcomes of dissecting posterior cerebral artery (PCA) aneurysms with emphasis on endovascular management in the form of parent vessel occlusion (PVO) at a tertiary care center. Methods Thirty-six dissecting PCA aneurysms (19 ruptured) encountered at our center between January 2013 and November 2019 were reviewed for aneurysm location/size/presence of fetal PCA/management. Postprocedural imaging of patients who underwent endovascular intervention was reviewed for PCA territory infarcts and clinical records assessed for presence of neuro-deficits and outcome. None of the patients underwent a balloon test occlusion (BTO) prior to PVO. Results The location of the aneurysms was as follows-P1 = 8/P1-P2 = 11/P2 = 5/P2-P3 = 10/P3 = 2. The mean size was 11.7x6.8 mm. Endovascular intervention was carried out in 20 patients in the form of PVO with coiling in 16 patients, coiling alone in 3 patients, and reconstruction of the left PCA with flow diverter deployment in one patient. Postprocedural PCA territory infarct was seen in 5 cases of PVO out of which 4 had a good functional recovery. Overall, 15/16 patients (93.7%) who underwent PVO had mRS ≤ 2 on follow-up. The single case with flow diverter also developed an infarct and had adverse outcome on follow up. Conclusion Among the various management strategies for dissecting PCA aneurysms, PVO is feasible and relatively safe even in absence of BTO in scenarios like critically ill patients with ruptured aneurysms, difficult access and financial constraints. Thromboembolic complications and antiplatelet therapy is a concern in reconstructive strategies. |
| Databáze: | OpenAIRE |
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