Deconstructive endovascular technique for dissecting posterior cerebral artery aneurysms: a single-center case series study

Abstract Background This study aimed to evaluate the safety and efficacy of the endovascular deconstructive artery technique in the treatment of dissecting posterior cerebral artery (PCA) aneurysms (P1 and P2 segments). We retrospectively analyzed the angiographic characteristics, technical data, and clinical outcomes of nine consecutive patients with dissecting PCA aneurysms treated by our team using the endovascular deconstructive technique between January 2019 and December 2022. The patients consisted of six males and three females ranging in age from 36 to 63 years (mean: 48.1 ± 9). Four patients had a P1 segment dissecting aneurysm, and five patients had a P2 segment dissecting aneurysm. Five patients presented with a headache, one patient presented with epilepsy and headache, and three patients presented with subarachnoid hemorrhage. Results A balloon occlusion test (BOT) was performed for one patient. Eight patients were treated by parent artery occlusion (PAO) using micro-coils, whereas one patient was treated by occluding the P2 segment dissecting aneurysm using NBCA glue. There were no cortical infarctions following the occlusion of the parent artery. Two patients with P1 occlusion experienced post-procedural small thalamic infarctions that resolved to mRs:1 at three months of follow-up. P2 segment occlusion was asymptomatic in all patients. One patient showed partial aneurysmal recurrence. Conclusions Endovascular parent artery occlusion is an effective and safe treatment approach for the dissecting aneurysms of PCA, even without an occlusion test. In addition, the risk of perforator infarction must be considered in P1 occlusion. Level of evidence Level 4, Case Series.