Journal of Cerebrovascular Disease 2020 Vol.3 No.3 15-26

Intentional Compartmentalized Embolization of Wide-neck Aneurysms Incorporating the Posterior Communicating Artery to Preserve Flow

Author(s): Feng Xiao¹,Nestor Gonzalez²,Min Yan²,Wei-Jian Fan²,Jun Gu²,Ren-Ya Zhan²,Jian-Wei Pan²

Affiliation(s): ¹Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University, School of Medicine
²Department of Neurosurgery, Ronald Reagan UCLA Medical Center

Corresponding Author: Jian-Wei Pan

Corresponding email(s): 1202053@zju.edu.cn

Key Words: Aneurysm; Compartmentalized embolization; Posterior communicating artery

Background: Endovascular coiling for wide-neck aneurysms with a branch arising from the aneurysmal sac is challenging and sometimes considered impossible. This study aims to present our experience in treating wide-neck internal carotid artery (ICA) aneurysms with a posterior communicating artery (PComA) arising from the sac using a strategy of stenting the ICA and intentional compartmentalization to preserve the flow in the PComA.

Methods: Eight consecutive cases of wide-neck ICA aneurysms with a fetal-type PComA arising from the aneurysmal sac were embolized from January 2015 to June 2018 at the First Affiliated Hospital, College of Medicine, Zhejiang University. Demographics, angiographic technique, procedural complications and clinical outcomes were reviewed.

Results: There were 2 men and 6 women ranging from 56 to 81 years of age. Of the 8 cases, 3 were ruptured and 5 were unruptured aneurysms. Stents were successfully deployed in all 8 cases. Near-complete occlusion was achieved in 3 cases (37.5%), neck remnant in 4 (50%) and sac remnant in one (12.5%) of the cases. One case suffered transient ischemic attack after procedure completion. The clinical outcome was favorable in all 8 cases (modified Rankin scale 0-1). No rebleeding occurred during clinical follow-up.

Conclusion: Stent-assisted compartmentalized embolization is feasible and safe in the treatment of wide-neck ICA aneurysm with a PComA arising from the sac.

Full Text: 

On-line Access: 2020-06-01

Received: 2019-06-15

Revision Accepted: 2019-08-26

Publish: 2020-06-01

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