Endovascular Treatment of Posterior Cerebral Artery Aneurysms
W.J. van Rooija,
M. Sluzewskia and
G.N. Beuteb
a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
b Department of Neurosurgery, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
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Fig 1. Patient 11, a 43-year-old woman with an incidentally discovered fusiform P2 aneurysm.
A, Lateral projection of vertebral aneurysm shows an 8-mm fusiform P2 aneurysm.
B, Simultaneous angiogram of vertebral artery and right internal carotid artery shows complete occlusion of the aneurysm including the parent PCA and good filling of distal PCA branches through leptomeningeal collateral vessels.
C, MR imaging 6 weeks after PCA occlusion shows no infarction in PCA territory.
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Fig 2. Patient 20, a 32-year-old man presenting with HH grade III SAH and hemianopsia.
A, CT scan on the day of admission shows SAH and aneurysm in the left ambient cistern (arrow).
B, Vertebral angiogram shows occluded left PCA beyond the P2, presumably by a dissecting aneurysm. Endovascular therapy was judged not necessary.
C, CT scan after sudden clinical detoriation 4 days after admission shows enlargement of the aneurysm, recurrent SAH with thalamic hematoma and hemorrhagic infarction in the PCA territory.
D, Angiogram after recurrent SAH shows filling of large dissecting aneurysm.
E, Occlusion of the aneurysm with coils including the afferent P2. The patient died 3 days later.
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Fig 3. Patient 13, a 64-year-old man presenting with HH grade I SAH and right occulomotor palsy.
A and B, MR imaging and angiography show dissecting fusiform P2 aneurysm with intramural thrombus.
C and D, Vertebral (C) and right internal carotid (D) angiogram after occlusion of the aneurysm including the parent PCA show good collateral supply to the occipital lobe through leptomeningeal collaterals.
E, MR imaging 6 weeks after PCA occlusion demonstrates no infarction in right PCA territory.
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Fig 4. Patient 22, a 64-year-old woman presenting with HH grade I SAH and hemianopsia.
A, CT scan showing subarachnoid and intraventricular blood and a hematoma in the medial occipital lobe.
B, Lateral vertebral angiogram showing a small aneurysm on the P4 (arrow).
C, Superselective angiogram, which better demonstrates the small aneurysm.
D, Occlusion of the aneurysm including the parent artery with coils.
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Fig 5. Patient 12, a 35-year-old man presenting with acute left occulomotor palsy.
A and B, MR imaging and angiography show a left P1–P2 aneurysm pointing downward with an intramural thrombus.
C and D, Coiling of the aneurysm with the aid of a supporting balloon results in complete occlusion of the lumen.
E, CT scan 2 months later shows SAH from the coiled aneurysm. The patient died the next day.
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AJNR - American Journal of Neuroradiology