Hemorrhagic Dissection of the P1 Segment of Posterior Cerebral Artery Treated with Stent-Assisted Coil Embolization: A Case Report

Case Report

Austin J Cerebrovasc Dis & Stroke. 2016; 3(1): 1040.

Hemorrhagic Dissection of the P1 Segment of Posterior Cerebral Artery Treated with Stent-Assisted Coil Embolization: A Case Report

Nishimuta Y1,2*, Tomosugi T2, Kubo F1,2, Ito N1,2, Hirahara K2, Nagayama T3, Tokimura H1 and Arita K1

1Department of Neurosurgery, Kagoshima University, Japan

2Department of Neurosurgery, Kagoshima City Hospital, Japany

3Department of Neurosurgery, Atsuchi Neurosurgical Hospital, Japan

*Corresponding author: Yosuke Nishimuta, Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, 890-8544, Kagoshima, Japan

Received: April 17, 2016; Accepted: May 11, 2016; Published: May 13, 2016


Dissecting aneurysms of posterior cerebral artery (PCA) are very rare. We report a case with hemorrhagic dissecting aneurysm of the P1 segment of PCA treated by stent-assisted coiling. An otherwise healthy 47-year-old woman had sudden severe headache and vomiting. Brain CT showed subarachnoid hemorrhage thicker in the left ambient and prepontine cistern. 3D CTA revealed a fusiform dilatation of the P1 segment of left PCA. Because surgical intervention involved high risks for treatment-related morbidity and mortality, the patient was treated conservatively with antihypertensive and sedatives for seven days. Her clinical course was uneventful, and the irregularity of the PCA wall improved on magnet resonance angiogram (MRA) two weeks after the onset. One year after onset, however, MRA revealed recurrence of PCA dissection. The aneurysm was successfully treated by stent-assisted coiling using trans-cell technique without rebleeding. The aneurysm has not recurred on the latest DSA at 6 months after the treatment. Endovascular treatment with “stent assist” seems a reasonable choice for treating dissecting aneurysm involving the P1 segment of PCA.

Keywords: Stent-assisted coil embolization; Hemorrhagic P1 dissection; Posterior cerebral artery


Hemorrhagic dissecting aneurysms of cerebral artery tend to rebleed and the prognosis after rebleeding is poor. Hence, proactive treatments are given to prevent rebleeding. Posterior cerebral artery (PCA) aneurysms are quite rare, comprising approximately 1% of all intracerebral aneurysms [1]. Dissecting aneurysms account for about 35% of PCA aneurysms [2].

Endovascular treatment has been utilized as a modality of treatment of this rare entity [3]. But the proper choice of the treatment and the long term results are yet to be clear. We here report a case of hemorrhagic dissecting aneurysm of the P1 segment of PCA which was successfully treated with stent-assisted coiling.

Case Presentation

A 47-year-old homemaker woman with high blood pressure, which had been well controlled by medication, underwent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies (Figure 1A) due to pulsatile tinnitus in her left ear lasting for 1 week. The studies showed no abnormality. No irregular caliber of the left P1 segment was visible. She felt chronic tension headache since then. Seven days after the first MR studies, she was found to be standing in stuporous state in the shower room. She was lethargic with GCS 14 (E3, V5, M6) and high blood pressure (170/80 mm Hg) at the emergency room, computed tomography (CT) scan showed diffuse subarachnoid hemorrhage (SAH) which was thicker in the left side of ambient and prepontine cistern (Figure 2). Digital subtraction angiography (DSA) demonstrated fusiform enlargement and irregularity of the P1 segment of left PCA (Figure 1B arrow). The patient’s level of consciousness became normal after a week-long blood control using antihypertensives and small dose of sedatives. MRA at two weeks after admission showed smoothening of wall of the P1 segment (Figure 1C arrow heads).