A Case of Ruptured Middle Portion Posterior Communicating Artery Aneurysm with Ipsilateral Internal Carotid Artery Occlusion Treated by Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Endovascular Treatment

Abstract

We report a case of low-flow bypass and endovascular coiling for ruptured middle portion posterior communicating artery (PCoA) aneurysm with an ipsilateral internal carotid artery occlusion. A male in his 70s, who presented with headache was referred to our hospital. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage and a cerebral aneurysm in the middle portion of the PCoA, along with an ipsilateral internal carotid artery occlusion. First, we performed a right superficial temporal artery–middle cerebral artery bypass to minimize the risk of perioperative cerebral ischemia and symptomatic vasospasm; subsequently, coil embolization through the posterior circulation was performed. The patient showed a successful recovery at the 3-month follow-up and showed no recurrence 4 years after the treatment. Coil embolization for the middle portion in a PCoA aneurysm has a risk of parent artery occlusion and can result in an incomplete occlusion owing to the small diameter of the PCoA. However, the combination of bypass surgery with coil embolization can be an effective treatment option. This approach reduces the likelihood of perioperative ischemic stroke, symptomatic vasospasm, and recurrence, particularly when the pathogenesis of the aneurysm is hemodynamic stress caused by an occluded artery.