Background:
Intracranial aneurysms, in particular those originating from the posterior communicating artery (PcomA), segment of the internal carotid artery, present significant health risks due to their potential to rupture, causing subarachnoid hemorrhage with high morbidity and mortality rates. Existing literature predominantly covers multiple arteries, with focused data on PcomA aneurysms remaining limited. This study evaluates the clinical and radiological outcomes of PcomA aneurysms treated with either microsurgical or endovascular treatment (EVT), hypothesizing that differences in outcomes could guide treatment modalities.
Methods:
A continuous retrospective cohort analysis was performed with PcomA aneurysms treated between March 2007 and October 2023 at the University Hospital of Geneva. Data were collected from the Geneva AneuX database. Patients underwent treatment with surgical or EVT. Clinical outcomes were measured using the modified Rankin Scale (mRS) at three months and one year post treatment and radiological outcomes were assessed by the presence of residual flow within the aneurysm or its complete exclusion at one year.
Results:
Of the 89 patients, 31 underwent surgical treatment and 58 received EVT. Among this cohort, 52 were identified as unruptured, with 25 undergoing surgical treatment and 27 receiving EVT. Radiological outcomes at one-year post-treatment indicated a higher incidence of residual flow in the endovascular group (p < 0.05), suggesting incomplete aneurysm exclusion. Clinical outcomes measured by the mRS showed no significant differences between the treatment groups at three months and one-year post- treatment. The EVT group, however, required more frequent retreatments. For ruptured aneurysms, the analysis showed similar trends in treatment efficacy and retreatments.
Conclusion:
This pilot study demonstrates that both surgical and EVT are effective for PcomA aneurysms but have different implications for residual flow and retreatment. EVT, while less invasive, often results in higher residual flow, suggesting the need for more frequent monitoring and possible additional interventions. These findings highlight the importance of a personalized treatment approach, considering individual patient and aneurysm characteristics to optimize outcomes and reduce the need for further treatment.