Feasibility and midterm outcomes of endovascular embolization for true posterior communicating artery aneurysms

Endovascular treatment (EVT) of true posterior communicating artery (PcomA) aneurysms has been rarely reported. This study reports the outcomes on a single-center cohort with true PcomA aneurysms who underwent EVT.

Between June 2011 and June 2017, clinical data from 42 patients with 43 true PcomA aneurysms who underwent EVT were retrieved from a prospectively maintained single-center database. Endovascular techniques, perioperative complications, clinical outcomes, and angiographic results were retrospectively evaluated.

All aneurysms were treated successfully. Treatment modalities included simple coiling in 30 aneurysms, balloon-assisted coiling in two, and stent-assisted coiling in 11 cases. Immediate angiograms showed complete occlusion in 23 aneurysms (53.5%), residual neck in 8 cases (18.6%), and residual sac in 12 (27.9%). No procedure-related complications or mortality were observed. Of the 34 aneurysms that underwent angiographic follow-up at an average duration of 7.1 months post-procedure, complete occlusion was achieved in 22 (64.7%), neck remnant in eight (23.5%), and residual sac in four (11.8%) aneurysms, respectively. Six aneurysms (18.2%) that underwent conventional coiling developed recanalization and required retreatment. Seven cases that received stent-assisted coiling did not develop recurrence. Clinical follow-up (mean, 24.3 months) of all patients demonstrated no neurologic deterioration or (re)bleeding.

EVT of the true PcomA aneurysm is a safe and feasible procedure but may be associated with recurrence in midterm follow-up, requiring close surveillance and potential retreatment.