Neurointervention.  2022 Nov;17(3):183-189. 10.5469/neuroint.2022.00276.

Double-Balloon-Assisted Coiling for Wide-Necked Posterior Communicating Artery Aneurysms with a Fetal-Type Variant of the Posterior Cerebral Artery: A Case Series

• Nariai Y
• Takigawa T
• Hyodo A
• Suzuki K

• KMID: 2535954
• DOI: http://doi.org/10.5469/neuroint.2022.00276

Abstract

Endovascular treatment for wide-necked posterior communicating artery (PcomA) aneurysms with a fetal-type variant of the posterior cerebral artery (PCA) is often challenging. Since the complete occlusion rates achieved with the currently available treatment methods are unsatisfactory, we aimed to study the effectiveness of a double-balloon-assisted technique for these aneurysms. From September 2014 to August 2020, 6 consecutive patients with PcomA aneurysms with fetal-type PCAs and no previous treatment were treated with this technique at our institution (3 ruptured cases and 3 unruptured cases). The indication for this technique is that the neck of the aneurysm should significantly and broadly incorporate both the internal carotid artery and fetal-type PCA, such that a single-balloon remodeling and single stent would be inadequate to protect both the arteries. In all patients, the fetal-type PCAs were preserved without a stent and with adequate occlusion status. This double-balloon technique can be effective in the treatment of these aneurysms.

Keyword

Intracranial aneurysm; Embolization; Posterior cerebral artery; Follow-up studies

Figure

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  Fig. 1. Double-balloon-assisted coiling for right posterior communicating artery (PcomA) aneurysm with fetal-type posterior cerebral artery (PCA). (A) The aneurysm incorporates the internal carotid artery and fetal PCA. (B, C) Two Scepter XC catheters and a microcatheter for coiling (white arrow) are introduced. (D) Coiling is performed using 2 microballoon-catheters. (E) Only a microguidewire at the PcomA is left to examine stent placement at the PcomA. (F) Postprocedural angiogram showing adequate occlusion with PcomA patency.

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  Fig. 2. Double-balloon-assisted coiling for right posterior communicating artery (PcomA) aneurysm with fetal-type posterior cerebral artery with PcomA acutely originating from the internal carotid artery (ICA). (A) Right ICA angiogram shows the difficulty in direct advancement of a microguidewire towards the PcomA. (B) A Scepter is placed at the ICA distal to the PcomA origin. (C) The Scepter distal to the origin of the PcomA with inflation facilitates access of the microguidewire into the PcomA for the other Scepter. (D) Two Scepter XC catheters and a microcatheter for coiling (white arrow) are prepared. (E) The first coil was inserted and the protrusion of the coil into the parent arteries was checked with deflation of the 2 balloon catheters. (F) Complete occlusion with PcomA patency.

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