Coil embolization alone for large dissecting aneurysms in the p2 segment of the left posterior cerebral artery:a case report

MO Zhi-xiao; DING Xiao-qiang; CHEN Zu-wen

doi:10.13798/j.issn.1009-153X.2025.06.013

Abstract：Intracranial aneurysms are a common cerebrovascular disease.Posterior cerebral artery(PCA)aneurysms are uncommon among intracranial aneurysms,and dissecting aneurysms of the PCA are exceedingly rare.This article reports the case of a 16-year-old female who was admitted to the hospital due to 6 hours of dizziness accompanied by one episode of falling.Head CT revealed abnormal density shadows anterior to the brainstem and in the midbrain.Head MRI showed a mixed high and low signal intensity lesion in the pre-pontine cistern,which exhibited heterogeneous enhancement after contrast administration.Digital subtraction angiography revealed bilateral fetal-type posterior cerebral arteries and an aneurysm at the branch of the posterior temporal artery on the left P2 segment of the PCA,measuring 17 mm×9 mm,with a slender parent artery.Based on the CT,MRI,and DSA findings,a diagnosis of a large dissecting aneurysm on the left P2 segment of the PCA was made.After completing preoperative preparations,interventional therapy was performed.However,due to the large size of the dissecting aneurysm and the extremely slender parent artery,stent placement was not feasible.Consequently,coil embolization was chosen.Furthermore,to prevent mass effect and alleviate compression of the brainstem by the aneurysm,a treatment approach of loose intra-aneurysmal coil packing combined with parent artery occlusion was selected.Immediate post-procedural angiography did not show the aneurysm.A follow-up CTA at 3 years post-operation showed no recurrence of the aneurysm.The patient recovered well with no specific discomfort.This suggests that for intracranial dissecting aneurysms with specific anatomical features,parent artery occlusion can be a viable treatment option even when conventional stent-assisted techniques are not applicable.