Selective compromise of hypoplastic posterior communicating artery variants with aneurysms treatable by coil embolization: clinical and radiologic outcomes.
BACKGROUND
Posterior communicating artery (PcoA) compromise may serve as adjunctive treatment in patients with hypoplastic variants of PcoA who undergo coil embolization of PcoA aneurysms. However, procedural safety and the propensity for later recanalization are still unclear.


OBJECTIVE
To evaluate clinical and radiologic outcomes of coil embolization in this setting, focusing on compromise of PcoA.


METHODS
As a retrospective review, we examined 250 patients harboring 291 aneurysms of hypoplastic PcoAs, all consecutively treated by coil embolization between January 2004 and June 2016. PcoA compromise was undertaken in conjunction with 81 of the treated aneurysms (27.8%; incomplete 53; complete 28). Medical records and radiologic data were assessed during extended monitoring.


RESULTS
During the mean follow-up of 33.9±24.6 months (median 36 months), a total of 107 (36.8%) coiled aneurysms showed recanalization (minor 50; major 57). Recanalization rates were as follows: PcoA preservation 40.5% (85/210); incomplete PcoA occlusion 34.0% (18/53); complete PcoA occlusion 14.3% (4/28). Aneurysms >7 mm (HR 3.40; P<0.01), retreatment for recanalization (HR 3.23; P<0.01), and compromise of PcoA (P<0.01) emerged from multivariate analysis as significant risk factors for recanalization. Compared with PcoA preservation, complete PcoA compromise conferred more favorable outcomes (HR 0.160), whereas incomplete compromise of PcoA fell short of statistical significance. Thromboembolic infarction related to PcoA compromise did not occur in any patient.


CONCLUSION
PcoA compromise in conjunction with coil embolization of PcoA aneurysms appears safe in hypoplastic variants of PcoA, helping to prevent recanalization if complete occlusion is achieved.
['Choi|Hyun Ho|HH|', 'Cho|Young Dae|YD|', 'Yoo|Dong Hyun|DH|', 'Yeon|Eung Koo|EK|', 'Lee|Jeongjun|J|', 'Lee|Su Hwan|SH|', 'Kang|Hyun-Seung|HS|', 'Cho|Won-Sang|WS|', 'Kim|Jeong Eun|JE|', 'Han|Moon Hee|MH|http://orcid.org/0000-0002-0883-841X']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001807:Blood Vessel Prosthesis D002533:Cerebral Angiography D004621:Embolization, Therapeutic D005260:Female D005500:Follow-Up Studies D006801:Humans D002532:Intracranial Aneurysm D008297:Male D008875:Middle Aged D019233:Retreatment D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome D055815:Young Adult
compromise posterior communicating artery aneurysm coil embolization recanalization