Dissecting aneurysm of the posterior communicating artery

Endovascular Treatment Using a Small Amount of Contrast Medium in a Patient with a Posterior Communicating Artery Ruptured Dissecting Aneurysm and Chronic Kidney Disease: A Case Report

Objective

We report a rare case of a patient with a ruptured posterior communicating artery (P-com A) dissecting aneurysm and chronic kidney disease (CKD) treated by endovascular embolization using a small amount of contrast medium.

Case Presentation

An 88-year-old female patient had sudden onset of headache and vomit due to subarachnoid hemorrhage. MRI revealed a ruptured dissecting aneurysm of the right P-com A. The patient had CKD of severity grade 4. Endovascular treatment was performed using only 10 mL of diluted contrast medium with injection through a microcatheter. The postoperative course was uneventful, and no deterioration of renal function occurred.

Conclusion

With minimal amount of contrast medium, endovascular treatment could be safely and effectively performed for patients with P-com A dissecting aneurysms and severe CKD.

Microsurgical Treatment of Ruptured True Posterior Communicating Artery Aneurysm in the Distal Portion of the Posterior Communicating Artery

The true posterior communicating artery (PCoA) aneurysms in the distal portion of the posterior communicating artery are rare. The authors describe a 63-year-old woman with 1 true PCoA aneurysms in the distal portion of the PCoA, which was treated surgically through modified pterional approach. No neurologic deficit was present at the postoperative period. Although endovascular intervention is more and more widely used in the treatment of aneurysms, the authors have also emphasized that true PCoA aneurysms in the distal portion of the PCoA can also be surgically treated in suitable patients.

Subarachnoid hemorrhage from dissecting aneurysm of the posterior communicating artery

A 36-year-old woman on chronic hemodialysis presented with sudden onset of headache and deterioration of consciousness. She was sent to our hospital on day 1, with subarachnoid hemorrhage. Cerebral angiography showed pearl and string sign on the left posterior communicating artery, which was consistent with a diagnosis of hemorrhage from a dissecting aneurysm of the left posterior communicating artery. She underwent parent artery occlusion via endovascular treatment on day 2. Although cone beam computed tomography before embolization showed a perforator from the lesion, there were no ischemic lesions on diffusion-weighted imaging after the procedure. She was discharged without any neurological deficits. It is important to recognize that dissecting aneurysm of the posterior communicating artery is one cause of subarachnoid hemorrhage. We also discuss the utility of cone beam computed tomography in formulating the treatment plan for such patients.