Endovascular Interventional Therapy For Posterior Communicating Artery-Infundibular Dilatation Aneurysms

Objective: Posterior communicating artery-Infundibular dilatation is also called the funnel.It is mainly located in the posterior communicating artery from the internal carotid artery.The maximum diameter is often <3 mm.The partial volume can be increased and triangular,and the posterior communicating artery is emitted from the top of the cone.Posterior communicating aneurysms(PCo A-IDs)that occur at the beginning of the cone have an angiographic rate of 7% to 25% in the normal population.Because of the complex anatomical relationship of the posterior carotid artery,the location is special,the neck of the tumor is wide,and there is variability,it is still very difficult to treat intracranial aneurysms by endovascular treatment.Posterior communicating artery-Infundibular dilatation aneurysms start from the posterior traffic.Therefore,if the morphology is not properly analyzed during interventional surgery,it is prone to rupture and hemorrhage,which poses a serious threat to the patient's life.Therefore,this study was to observe the morphology,select appropriate interventional embolization method,effectively treat and improve the prognosis quality of life,reduce the incidence of complications,risk factors and possible mechanisms,and determine its impact on the prognosis of patients.Provide some reference for clinical diagnosis and treatment.Methods: From 2013 to 2016,1700 cases with complete imaging data were selected from Neurosurgery Department of our hospital.Posterior communicating artery cone,posterior communicating artery aneurysm and posterior communicating cone aneurysm were identified and further classified.Preoperative morphology of posterior communicating cone aneurysm was observed by medical imaging characteristics.Individualized endovascular embolization was performed in patients with posterior communicating cone aneurysms after a specific embolization protocol was developed.The cone was described by imaging,and the transition types needed to be intervened in advance were summarized,and the ruptured hemorrhagic aneurysms were classified accordingly.Statistical analysis data: general baseline data,degree of bleeding,Hunt-Hess classification,imaging characteristics of aneurysms,interventional therapy.According to the modified Rankin scale(m RS),the prognosis of clinical follow-up was evaluated.The risk factors of cerebral infarction and rebleeding after interventional treatment of ruptured aneurysms of conus communis were analyzed in multiple ways,and the mechanism and effective measures of prediction were discussed.Results: 141 posterior communicating aneurysms,43 cones and 38 cones were found.38 cases of posterior communicating cone aneurysms treated by interventional embolization were analyzed.The following conclusions were drawn: 1.Statistical analysis showed that the incidence of posterior communicating cone aneurysms was 4.3%,and that of posterior communicating cone aneurysms was 18.1%.2.According to imaging analysis,it is feasible to classify conus and its aneurysms into A,B,C and D types.3.Although there was no significant difference between the sexes in type D conical aneurysms,the incidence of female aneurysms was very high(86.8%),suggesting that sex chromosomes may be related to the formation of conical aneurysms.4.In this study,interventional embolization has been successfully performed in all patients treated with interventional therapy,and the success rate of this interventional therapy is 100%.Among the 38 patients,17(44.7%)had stent-assisted coil embolization and 21(55.3%)had simple coil embolization.5.In general baseline data analysis,female patients with ruptured conical aneurysms had a higher incidence(86.8%),which was positively correlated with age.6.There were significant differences in age,preoperative Hunt-Hess classification,stent-assisted,primitive posterior cerebral artery and aneurysm size.There was no significant difference in gender,past medical history,neck width and treatment between groups(all P > 0.05).Conclusion: 1.Preoperative image morphology analysis is helpful for the classification of conical and conical aneurysms.2.Intravascular interventional therapy for posterior communicating conus aneurysms has achieved very good results,especially for wide-necked aneurysms,giant aneurysms and multiple aneurysms,as well as complex aneurysms which are difficult to treat surgically,the therapeutic effect of interventional embolization is satisfactory.3.In endovascular interventional therapy,skilled interventional techniques are needed.The possible complications should be carefully considered before operation and the corresponding plans should be formulated.4.Endovascular interventional success rate is high.Most patients with successful embolization have good prognosis.A few patients have recurrence of early cerebral infarction and hydrocephalus after operation because of critical condition and complex aneurysm structure.5.Age,Hunt-Hess grading before operation,stent-assisted,primitive posterior cerebral artery and size of aneurysm have influence on prognosis.Other factors such as sex,past medical history and neck width had no definite effect on the prognosis of interventional therapy.6.This study confirms that good prognosis can be obtained by observing the morphology of ruptured aneurysms of the conus arteriosus before operation and choosing the correct embolization scheme.