Endovascular embolization of a de novo treu posterior communicating artery aneurysm 23 years after surgical clipping of an ipsilateral posterior communicating artery-internal carotid artery aneurysm: A case report

Abstract

We describe a true posterior communicating artery (PCoA) aneurysm, which is an uncommon variant of intracranial aneurysm that was treated by endosaccular embolization. A 64-year-old woman was admitted for management of an unruptured left PCoA aneurysm. She had undergone microsurgical clipping of an ipsilateral internal carotid artery (ICA)-PCoA aneurysm 23 years prior to the current presentation. Angiography showed a saccular aneurysm 3 mm distal to the junction of the ICA and the fetal-type PCoA arising on the opposite side of the vessel to that of the previous clipping. Endovascular embolization was performed to occlude the lumen of the aneurysm while preserving the patency of the PCoA. Based on angiograms, hemodynamic stress seems to be the most feasible explanation for the de novo development of an aneurysm at the first acute bend within the PCoA in our patient. For this anatomical reason, endosaccular coil deployment was possible without the use of a balloon or stent.