Neurointervention.  2024 Mar;19(1):57-60. 10.5469/neuroint.2023.00472.

Fusiform “True” Posterior Communicating Artery Aneurysm with Basilar Artery Occlusion: A Case Report

• Shah R
• Saraf R

• KMID: 2552881
• DOI: http://doi.org/10.5469/neuroint.2023.00472

Abstract

Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.

Keyword

Posterior communicating artery; Intracranial aneurysm; Fusiform aneurysm; Stent-assisted coiling

Figure

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  Fig. 1. A patient with sudden onset severe headache. (A) Brain CT showing diffuse subarachnoid hemorrhage. (B) Right internal carotid angiogram showing acutely ruptured fusiform aneurysm of the PCoA in its middle and posterior third junction with reformation of the basilar artery through the PCoA. (C) Left vertebral angiogram shows proximal basilar occlusion. (D) Right ICA angiogram show the morphology of the fusiform true PCoA aneurysm with extreme tortuosity in its entire course (arrows and arrowhead). (E) Plain radiograph in lateral view. The deployment was completed with good positioning of the stent and being a 4.5 mm stent there was a good opening of the stent in proximal fusiform segment of the aneurysm (stent outlined in white, white arrow). (F) Post-stenting angiogram showed good flow in the reformed basilar artery and its branches. (G) Plain radiograph in lateral view showing the coil mass and the stent. (H) Final right ICA showing complete exclusion of the saccular component of the sacculofusiform aneurysm and good flow in the reformed basilar artery. CT, computed tomography; PCoA, posterior communicating artery; ICA, internal carotid artery.

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