Fetal-type posterior communicating aneurysm

• Influence of Fetal-Type Posterior Cerebral Artery on Morphological Characteristics and Rupture Risk of Posterior Communicating Artery Aneurysms: A Radiomics Approach
• Morphology and Variations of the Posterior Cerebral Artery: A Literature Review
• Association of middle cerebral artery aneurysms and variation of the A1 segment
• Rare simultaneous fetal posterior cerebral artery and conventional posterior cerebral artery duplication in a patient with a ruptured posterior communicating artery aneurysm: illustrative case
• A case of bilateral vertebral artery dissection treated by bilateral surgical occlusion and low-flow bypass
• Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery
• Efficacy and safety of fetal posterior cerebral artery stented coil embolization for fetal posterior cerebral aneurysms
• Impact of branch arteries on efficacy of endoluminal flow diverters: Insights from posterior communicating artery aneurysms

There is a significant association of aneurysm formation and rupture of posterior communicating artery aneurysm in the presence of Fetal-type posterior cerebral artery. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall ¹⁾.

Chen et al. retrospectively reviewed the experience and results of endovascular treatments for a series of nine consecutive patients with PcomA aneurysms occurring at the origin of fetal PCAs at the Department of Neurosurgery of Southwest Hospital, Chongqing, China, between June 2011 and June 2014. Depending on the angiographic findings, location and shape of the aneurysms, various therapeutic strategies were used including coiling by single or double microcatheter, balloon remodeling technique, and single or Y-stenting technique. Overall, fetal PCA was preserved patent in all cases, and complete or near complete occlusion was achieved in 8/9 cases. There was no procedure-related morbidity or mortality. With the exception of one patient who died of pneumonia 6 weeks after treatment, no clinical evidence of neurologic deterioration and hemorrhagic complication was seen during the follow-up period in the remaining 8 patients. Our experience suggests that endovascular treatment is relatively safe and technically feasible in most patients with PcomA aneurysms in the presence of fetal PCA using multiple strategies ²⁾.

Results suggested that PCoA aneurysms with fetal-type PCAs had different morphological features and hemodynamic characteristics compared with those with adult-type PCAs, leading to high risks of recanalization ³⁾.

Stenting into fPCA for aneurysms with fPCA incorporated into the aneurysm achieved high-density complete embolization without increasing complications, and prevented recanalization. The fPCA stent-assisted coil embolization can offer an alternative treatment for fPCA aneurysms ⁴⁾

A meta-analysis suggests that flow diversion is a safe treatment option for Pcomm aneurysms, regardless of fetal-type Pcomm morphology. However, on the other hand, the findings indicate that Pcomm anatomy or the presence of jailed large branches can affect the efficacy of flow diverter treatment ⁵⁾

The performance of FDs in PComA aneurysms is comparable with outcomes found in other subtypes of supraclinoid aneurysms. Effectiveness was acceptable and safety favorable. However, effectiveness was suboptimal in patients with fetal-type PComAs; alternative treatments should be considered in these cases ⁶⁾.

• Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery
• T-Stent or Half T-Stent-Assisted Embolization of Wide-Necked Aneurysms at the Internal Carotid-Posterior Communicating Artery Bifurcation
• Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis
• Is Fetal-Type Posterior Cerebral Artery a Risk Factor for Recurrence in Coiled Internal Carotid Artery-Incorporating Posterior Communicating Artery Aneurysms? Analysis of Conventional Statistics, Computational Fluid Dynamics, and Random Forest With Hyper-Ensemble Approach
• Treatment of a ruptured fetal-type posterior communicating aneurysm with a combined approach using the new contour neurovascular system
• Posterior Communicating Artery-incorporated Internal Carotid-Posterior Communicating Artery Aneurysms Prone to Recur After Coil Embolization
• Recurrence and risk factors of posterior communicating artery aneurysms after endovascular treatment
• Risk Factors for the Recurrence of Posterior Communicating Artery Aneurysm: The Significance of Fetal-Type Posterior Cerebral artery

The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion ⁷⁾

The fetal-type posterior cerebral artery (FPCA) has been regarded as the risk factor for recurrence in coiled internal carotid artery-incorporating posterior communicating artery (ICA-PCoA) aneurysm. However, it has not been proven in previous literature studies. The gathered results of all 3 analyses show more clear evidence that FPCA is not a risk factor for coiled ICA-PCoA aneurysms. Hence, we may conclude that FPCA itself is doubtful to be the major risk factor in the recurrence of coiled ICA-PCoA aneurysms ⁸⁾.

Incidental Aneurysms (detected due to vertigo) in the right posterior communicating artery segment.

DIAGNOSTIC CEREBRAL ANGIOGRAPHY

Clinical data: Patient with vertigo in whom a small aneurysm in the right posterior communicating artery segment is identified in brain MRI.

Cerebral angiography.

REPORT: Access route: Right femoral. Introducer: 5F. Diagnostic catheter: 5F Vertebral. Guide: Terumo 0.035“. Explored arteries: Right posterior communicating artery, Left posterior communicating artery, Right vertebral artery, Left vertebral artery. Hemostasis: Mynxgrip Control vascular closure. Procedure performed without complications or other immediate incidents.

Findings:

After local anesthesia, ultrasound-guided puncture of the right femoral artery is performed with a 5F introducer.

The right anterior cerebral artery, left anterior cerebral artery, and both vertebral arteries are catheterized, performing several angiographic series in AP, lateral, oblique views, and a 3D rotational study from the right posterior communicating artery.

An aneurysm in the right posterior communicating artery segment is observed, with a common origin with the posterior communicating artery (fetal origin on the right side). Dimensions: 3.3 mm height, 5.6 mm width. Neck 2.7 mm. Maximum size 5.6 mm. Irregular morphology. Oriented posterolaterally.