gms | German Medical Science

Objective: Aneurysms of the posterior communicating artery (PCoA) those are located some distance away from the junction of the internal carotid artery (ICA) have been reported to be “true” PCoA aneurysms. They are extremely rare with incidence ranges from 0.1% to 2.8% of all aneurysms. We encountered 2 cases of true PCoA aneurysms those are treated by endovascular surgery.

Case 1: A 64-year-old woman presented with sudden onset of headache. Computed tomography (CT) scan showed diffuse thick subarachnoid hemorrhage. She was classified as WFNS grade II. Digital subtraction angiography (DSA) showed a right PCoA aneurysm. And coil embolization was performed on Day 1. During the procedure, balloon assist technique was introduced because of broad neck. No evidence of fresh ischemic lesion was detected on the post embolization CT scan. The patient presented no neurological symptoms after ventriculo-peritoneal shunt for communicating hydrocephalus. No recanalization was observed on the follow-up angiography taken on 2 months later.

Case 2: A 79-year-old-man presented with right blephaloptosis. Suspecting a right ICA – PCoA aneurysm on magnetic resonance image, he was referred to us for treatment. DSA showed a right true PCoA aneurysm. The aneurysm was dumb-bell shape and projected inferolaterally. Coil embolization was performed 3 days later. Post embolization course was uneventful and the right oculomotor palsy resolved gradually. Neither case showed remaining neurological symptoms or rerupture. These experiences suggest that endovascular surgery is feasible for these lesions from the standpoint of less invasive surgery. But special consideration must be paid to the perforating arteries from the PCoA.