J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):124-128. 10.7461/jcen.2016.18.2.124.

Retrograde Stent-assisted Coil Embolization of Wide-neck or Branch-incorporated Posterior Communicating Artery Aneurysm

• Park JW
• Cheong JH
• Choi KS
• Park DW
• Ryu JI
• Kim JM
• Kim CH

• KMID: 2354888
• DOI: http://doi.org/10.7461/jcen.2016.18.2.124

Abstract

Endovascular coil embolization using a balloon- or stent-assisted technique for the treatment of wide-necked posterior communicating artery (PcomA) aneurysms is well established. However, complete aneurysm occlusion with preservation of the PcomA can be difficult in case of wide-neck aneurysms with a PcomA incorporation. We present two cases of stent-assisted coil embolization using a retrograde approach through the posterior circulation for wide-neck or branch-incorporated PcomA aneurysms. Retrograde stenting was successful without periprocedural complications. These aneurysms were completely occluded. The patency of the PcomA was maintained in all cases.

Keyword

Endovascular procedure; Posterior communicating artery aneurysm; Stents

MeSH Terms

Aneurysm
Arteries
Embolization, Therapeutic*
Endovascular Procedures
Intracranial Aneurysm*
Stents

Figure

• 

  Fig. 1 (A) A cerebral angiography revealed a wide-neck aneurysm at left posterior communicating artery. (circle) (B) Microcatheter for stenting was positioned to left M1 via PcomA. (C) Final angiography showed a complete occlusion of aneurysmal sac with four detachable coils and retrograde stenting. (Asterisk : ICA, Yellow arrow : Posterior communicating artery, White arrow : P1 of posterior cerebral artery, Two arrowheads : Both ends of stent) (D) A follow-up angiography at 18 months showed no evidence of recurrent of aneurysmal sac. Straight of stenting was observed. (two arrowheads are the both ends of stent). ICA = internal carotid artery.

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  Fig. 2 (A) Cerebral angiography demonstrated a branch-incorporated aneurysm at left posterior communicating artery. (B) The stent delivery microcatheter was placed acrossing the aneurysmal neck via P1-PcomA. (arrows) (C) Retrograde stenting was performed from terminal ICA to PcomA. (two arrows are the both ends of stent) (D) Final angiography showed a complete occlusion of the aneurysm maintaining the patency of PcomA flow. PcomA = posterior communicating artery; ICA = internal carotid artery.

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