The safety and efficacy of stenting in the treatment of complex posterior cerebral artery aneurysms: a seven-case report and literature review.

OBJECTIVE: To investigate the safety and efficacy of stenting with coil in the endovascular treatment of complex posterior cerebral artery (PCA) aneurysms.
METHODS: The data on PCA aneurysms treated with stents were retrospectively reviewed from a prospectively collected intervention database. The literature was reviewed concerning the use of stents for PCA aneurysms.
RESULTS: Seven cases with complex PCA aneurysms (male: female = 6:1; ruptured: unruptured = 4:3) were retrieved from our database. Three aneurysms were localized at the junction of P1 and P2 segments (P1-2), two at P1, and two at P2A. Four were wide-necked saccular aneurysms, while the other three were dissecting ones. A total of nine stents (one Neuroform and eight Enterprise stents) were successfully deployed. Two aneurysms were totally eliminated, three were with neck residues and two were partially occluded. No procedure-related complications occurred. All patients recovered well. Angiographic follow-ups (FU) showed that three aneurysms achieved total obliterations, one got improved, two remained stable, and one recurred. The recurred aneurysm caused no symptom and was treated with two stents. Clinical FU demonstrated no neurological deterioration or bleeding. In literature review, the procedure-related mortality is 5.3 % (2/38). The incidence of permanent neurologic deficit is 2.6 % (1/38). Three (3/23) aneurysms recurred, of which one caused rebleeding. Four (4/23) in-stent stenoses were all asymptomatic. No other hemorrhagic or ischemic event occurred in clinical FU.
CONCLUSION: Stent offers a therapeutic alternative for complex PCA aneurysms especially when PVO cannot be tolerated. Long-term therapeutic efficacy requires further observations in clinical series with larger case numbers.