Flow-diverter stents alone and in combination with coiling as treatment options for unruptured, symptomatic true PcomA aneurysms

Abstract

Background

True posterior communicating artery (PcomA) aneurysms are rare compared to those at the junction of the internal carotid artery (ICA) and PcomA. They account for a small subset of unruptured intracranial aneurysms, yet approximately 20 % present with ophthalmoplegia, significantly impairing quality of life. While direct third nerve compression was considered the primary cause of symptoms, evidence suggests that restricted blood flow can alleviate symptoms. Flow-diverter (FD) stents, while effective for complex aneurysms, are scarcely reported for symptomatic, unruptured true PcomA aneurysms.

Methods

A retrospective study (March 2015–December 2023) included patients with unruptured, saccular true PcomA aneurysms presenting with ophthalmoplegia. Data on demographics, aneurysm characteristics, interventions, clinical outcomes, and occlusion were analyzed.

Results

Endovascular treatment involved loose coiling with an FD in 9 patients (60 %) and FD alone in 6 patients (40 %). All procedures were successful, with no complications. Angiographic follow-up showed total occlusion in 13 out of 15 aneurysms (87 %). At six months, 60 % of patients had complete resolution of ophthalmoparesis, and 40 % showed partial improvement. By 12 months, 73.3 % had complete symptom resolution, and 26.7 % exhibited partial improvement.

Conclusion

FD stents, used alone or with coiling, are promising for treating symptomatic, unruptured true PcomA aneurysms, showing high occlusion rates, safety, and symptom relief. Despite the study’s retrospective design and small cohort, findings highlight the potential of this approach, warranting larger multicenter studies.