Title

Endovascular treatment for aneurysms of the posterior cerebral artery : 12 years' experience with 21 cases

Author(s)

Kashiwazaki, Daina; Ushikoshi, Satoshi; Asano, Takeshi; Osanai, Toshiya; Kuroda, Satoshi; Houkin, Kiyohiro

Citation

Acta Neurochirurgica, 153(11), 2151-2158
https://doi.org/10.1007/s00701-011-1111-5

Issue Date

2011-11

Doc URL

http://hdl.handle.net/2115/50371

Rights

The original publication is available at www.springerlink.com

Type

article (author version)

File Information

AN153-11̲2151-2158.pdf

Instructions for use

Hokkaido University Collection of Scholarly and Academic Papers : HUSCAP

Endovascular treatment for aneurysms of the posterior
cerebral artery:12 years experience with 21 cases.
Daina Kashiwazaki, MD, Satoshi Ushikoshi, MD, Takeshi Asano, MD, Toshiya Osanai, MD,
Satoshi Kuroda,MD, Kiyohiro Houkin, MD

Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Japan

Corresponding Author
Daina Kashiwazaki MD
Department of Neurosurgery, Hokkaido University Hospital,
Nishi7, Kita15, Kitaku, Sapporo 060-8638 Japan
gktqx702@yahoo.co.jp

1

Abstract

Background and Purpose: To discuss and summarize the strategies and complications of endovascular
embolization for aneurysms of the posterior cerebral artery (PCA).

Methods: Data of patients with PCA aneurysms treated by an endovascular procedure were analyzed
retrospectively (n = 21). Twenty patients with aneurysms were treated by detachable coil embolization,
and 1 patient was treated with n-butyl cyanoacrylate. Of the 21 aneurysm embolization cases, 9 were
treated by parent artery occlusion (PAO), and 12 were treated by selective occlusion of the aneurysm
(SOA).

Results: All 12 aneurysms treated by SOA showed complete occlusion. Two aneurysms became
recanalized 6 months after the first embolization and were then re-embolized; complete healing was
observed on follow-up angiography. All patients showed acceptable outcomes without any procedural
complications, except 1 patient who died 2 days after treatment. PAO resulted in 100% occlusion of all
aneurysms. Cerebral infarction was noted in most patients (78%). However, the area of infarction was
small. Permanent neurological deficit was observed in 2 patients (22%), but their condition was not
critical.

Conclusions: Aneurysm embolization with SOA is well indicated for saccular aneurysms with
well-defined necks, whereas PAO carries a risk of ischemic complications. Although the PCA is rich in
collateral circulation, ischemic complications were noted in most patients after PAO, and it was difficult
to predict occurrence of these complications. However, the area of cerebral infarction tended to be small,
and the neurological deficits observed were not critical.

Key words: aneurysm, endovascular treatment, posterior cerebral artery, parent artery occlusion.

2

Introduction
Aneurysms of the posterior cerebral artery (PCA) are rare, constituting approximately 0.7–2.3% of all
intracranial aneurysms [7, 9, 11, 14]. Surgical approaches to the treatment of PCA aneurysms are
complicated by their anatomy [12, 19–22]; however, intravascular surgery is useful for repairing
aneurysms in this region. In this study, patient outcomes after endovascular surgery for PCA aneurysms
were investigated retrospectively. The application and associated limitations of the technique are
discussed.

Methods
Patients
During a 12-year period, from 1998 to 2010, we retrospectively analyzed data of all patients with PCA
aneurysms who were treated with an endovascular procedure. Patients with aneurysms of the posterior
communicating artery were excluded from the study. In all, 21 patients with aneurysms were treated with
an endovascular procedure (7 men and 14 women; age, 33–78 years; mean age, 60.9 years). Of the 21
aneurysms, 15 were saccular and 6 were fusiform. Clinically, 15 patients were diagnosed with
subarachnoid hemorrhage (SAH), 1 patient was diagnosed with mass sign, and 5 patients were
asymptomatic. One patient had PCA aneurysm associated with moyamoya disease, 1 had an unruptured
arteriovenous malformation, and 1 had a dural arteriovenous fistula. The neurological status of all the
patients was recorded at admission by using the Hunt and Kosnik grading system (H–K grade). Follow-up
data were collected using the most recent outpatient records. Clinical outcomes were assessed by 2
experienced clinicians using the Glasgow outcome scale. Conventional angiography or magnetic
resonance imaging (MRI) time-of-flight angiography was performed at 6–12 months to determine
whether lesions had reduced or healed. Thereafter, additional image evaluation was performed annually,
if required. In particular, parent artery occlusion (PAO) cases were evaluated by computed tomography
(CT), MRI, and the assessment of neurological symptoms in detail, 1 day and 7 days after the treatment.
Aneurysm locations were classified as follows: P1 (3 cases), P1–2 (4 cases), P2 (5 cases), P2–3 (4 cases),
P3 (2 cases), and P4 (3 cases; Table 1). All procedures were performed under general anesthesia. In all
cases, 3000 IU of heparin was administered at the start of the procedure, followed by 1000 IU every hour
until completion of the procedure.

Strategy of intervention
Diagnostic angiography was performed in all patients before embolization. Selective occlusion of the
aneurysm (SOA) was the preferred procedure for all the patients. In cases where it was difficult to
perform SOA safely (because of thrombosed, small, fusiform, berry, or dissecting aneurysms), or the
location of the aneurysm was distal to the P2a segment, embolization was performed by PAO. PAO was
performed by placing coils in both the aneurysm sac and the parent artery. PAO was carried out at sites

3

proximal and distal to the neck of the aneurysm. The smallest possible length of the artery was occluded
using detachable coils. In the case of fusiform aneurysm, embolization was performed in the aneurysmal
dilatation. Coils were selected based on the size of the artery to be occluded. All PAO interventions were
performed without the involvement of surgical bypass procedures.

Anatomy of the posterior cerebral artery

In this study, PCA anatomy was classified as described by Drake et al. [10]. The PCA is divided into 4
segments: P1 arises from the basilar artery to the junction with the posterior communicating artery, P2
extends to and includes the first major branch on the side of the midbrain, P3 runs within the
perimesencephalic cistern up to the origin of the parieto-occipital and calcarine arteries, and P4 represents
the termination of the artery.

Results
We identified 21 patients with PCA aneurysms. Of these, 12 patients were treated by SOA, and 9 patients,
by PAO. The results are summarized in Table 1.

Selective occlusion of the aneurysm
All of the 12 aneurysms treated by SOA showed complete radiographic occlusion. No
technique-associated complications were noted. Two cases (16.7%) became recanalized 6 months after
the first embolization. Both of these cases were re-embolized and showed complete healing in the
follow-up angiogram. One of the 12 SOA cases was a large aneurysm, with oculomotor palsy as a mass
sign. After SOA, the patient’s double vision disappeared. Seven patients presented with SAH, and 4 were
asymptomatic. The outcomes of all of the patients in the 12 cases were favorable, except 1 (patient in case
8), who presented with SAH H–K grade 4 and had severe disability (SD).

Parent artery occlusion
All patients showed acceptable outcomes without any procedural complications, except 1, who died 2
days after treatment. This was caused by increased intracranial pressure. PAO resulted in 100% occlusion
of all the aneurysms. Although the PCA is rich in collateral circulation, cerebral infarction was noted in
mostpatients (78%). However, the area of infarction was small. Permanent neurological deficit occurred
in 2 cases (22%), but they were not critical. The aneurysm types treated by PAO were thrombosed (n = 3),
fusiform (n = 1), saccular (n = 3), dissection (n = 1), and berry (n = 1).

Illustrative cases
Case 6: A 66-year-old woman was diagnosed with SAH (H–K 1), with large thrombosed aneurysms.

4

MRI was useful in the diagnosis of SAH. Cerebral angiography revealed a large aneurysm of the left P2
segment. The patient underwent PAO of the P2 segment in areas immediately proximal and distal to the
aneurysm and in the aneurysm sac; this technique was performed using a detachable coil for re-rupture
prevention. Radiographically, the aneurysm was occluded, and postoperative MRI revealed cerebral
infarction in the PCA territory (thalamus and occipital lobe). The patient had incomplete homonymous
hemianopsia and numbness of the fingers. After 2 years, follow-up magnetic resonance angiography
(MRA) showed no evidence of subsequent aneurysm (Fig. 1).
Case 7: A 69-year-old woman with sudden headache and vomiting was diagnosed with SAH (H–K 4).
CT images indicated SAH. Cerebral angiography revealed a small aneurysm of the right P3 segment.
PAO was performed using a detachable coil directly proximal and distal to the aneurysm and in the
aneurysm sac. Although postoperative CT images showed cerebral infarction in the occipital lobe, the
patient’s vision was clinically preserved (Fig. 2).
Case 5: A 74-year-old woman had a chief complaint of double vision. MRI showed a large aneurysm
compressing the midbrain. Neurologically, oculomotor nerve palsy was observed. Complete occlusion
was noted after SOA using a detachable coil. Three months after the treatment, oculomotor palsy had
disappeared. Follow-up MRA showed no evidence of aneurysm recurrence (Fig. 3).

Discussion
Selective occlusion of the aneurysm
Since the international subarachnoid aneurysm trial (ISAT) [16], endovascular coiling is increasingly
used as the primary treatment option for indicated ruptured or unruptured aneurysms. In the present study,
2 cases became recanalized and were retreated without complication. SOA for the treatment of PCA
aneurysms resulted in favorable outcomes. Generally, surgical approaches to the treatment of PCA
aneurysms are anatomically difficult, and the perforating branches of the P1 segment are vulnerable to
injury. Some studies do suggest the use of surgical techniques and a skull-base approach, but direct
surgery continues to remain a challenge [12, 19–22]. These observations suggest that SOA should be the
first choice for the treatment of saccular aneurysms of the PCA. Clinical studies have yielded favorable
findings for endovascular treatment, which preserves the parent artery in this lesion type [6, 18, 23].
However, symptomatic aneurysms of the PCA, especially those of the P2 or distal segments, tend to be
larger and thrombosed [11]. SOA in these areas, compared to SOA for aneurysms located in the P1
segment, is less safe. This discrepancy is attributable to embryological differences. The P1 segment of the
PCA and the basilar artery have identical origins, whereas the P2 and distal segments belong to the
so-called “true PCA.” However, treatment in cases of giant aneurysms in the P1 segment continues to be
challenging.

Parent artery occlusion

5

Biondi et al. reported that endovascular occlusion of the parent artery appears to be a relatively safe and
effective technique in the treatment of peripheral giant and large aneurysms [2]. Hallacq et al. discussed
the safety of PAO as a treatment for aneurysms in the P2 segment [13]. In the literature, 6 series (38
cases) report the use of endovascular PAO for PCA aneurysms by using bare metal coils [1, 2, 6, 13, 23,
25] (Table 2).
Radiological results: In our series, PAO resulted in 100% occlusion of all the aneurysms. As in previous
studies, no patient presented with recanalization after PAO using detachable coils. These results suggest
that PAO is an effective method to obliterate PCA aneurysms.
Clinical results: Seven of the 9 patients who underwent PAO (78%) had cerebral infarction after the
treatment. This included 5 patients with infarction in the occipital lobe, and 2 patients with infarction in
the occipital lobe and thalamus. Although the PCA is rich in collateral circulation, cerebral infarctions
were noted in most patients, and it was difficult to predict their occurrence. However, the area of cerebral
infarction after PAO tended to be small. Some studies have indicated the relative safety and a low
probability of permanent neurological deficit after PAO [1, 8, 13, 17], but few radiological studies have
elucidated the area of cerebral infarction after PAO [18]. We believe that our strategy of occluding the
smallest possible length of the artery, by placing coils directly proximal and distal to the aneurysm and
within the aneurysm sac, is not different to previously reported strategies. PAO has the potential to induce
cerebral infarction, detected by MRI, both with and without neurological deficit. In our study, most
cerebral infarction occurred in the occipital lobe. However, 1 patient (case 6) had thalamic infarction due
to PAO at P2a, resulting in occlusion of the thalamogeniculate artery arising from P2 segment. Previously,
3 cases of thalamic infarction after PAO have been reported (1 case in a P2 aneurysm, 2 cases in P2–3
aneurysms). Most neurological deficits consisted of homonymous hemianopsia. In this study, 1 patient
had homonymous hemianopsia, and 1 patient had homonymous hemianopsia and numbness as the
permanent deficits (22% of cases). These findings suggest that PAO is a comparatively safe procedure for
the treatment of aneurysms located in or distal to the P2 segment, and that SOA cannot be performed
safely at a site distal to the P2 segment. The use of PAO should be limited to cases that require
interventional treatment. In cases of flow-related aneurysms in unruptured brain arteriovenous
malformation (BAVM) or dural arteriovenous fistula (DAVF), and small dissecting aneurysms that have
the potential for spontaneous healing, it is necessary to obtain sufficient data about the risks and benefits
of the method before its use.

Aneurysm sac embolization in parent artery occlusion
In the current study, coils were placed in both the parent artery and the aneurysm sac during PAO in all
cases. Five previous studies report performing PAO in this way. Only in 1 study, conducted by Biondi et
al., occlusion of the parent artery without aneurysm sac occlusion was performed for the treatment of
large and giant aneurysms. When considering the angiographic results, there are no differences between

6

PAO carried out with and without aneurysm sac embolization (all cases presented no recanalization).
There were no statistically significant differences in permanent deficit between the 2 methods (Fisher’s
exact test, p = 0.372). Boindi et al. suggested that elective PAO at the level of the aneurysm without the
insertion of coils into the aneurysm could increase shrinkage and resorption of giant aneurysms.
Therefore, the treatment of giant or large aneurysms with PAO without aneurysm sac embolization may
be beneficial; however this issue remains controversial.

The choice between open surgery and endovascular treatment
Aneurysm of the proximal segment of the PCA can be treated by a surgical approach normally used for
basilar top aneurysms. However, aneurysms in very high or low positions make open surgery difficult. In
this segment, the perforating artery supplying the brain stem must be protected. Pterional, subtemporal,
combined pterional and subtemporal, and posterior interhemispheric surgical approaches have been
reported for aneurysms located in or distal to the P2 segment. However, the use of these approaches is
still controversial owing to their associated anatomical challenges. For these reasons, endovascular
treatment remains a useful intervention for aneurysm of the PCA. Previous studies have indicated the
safety of PAO in this segment [1, 8, 13, 17]. However, some patients develop visual field loss after PAO.
In other groups, open bypass was performed to prevent visual field loss. During endovascular treatment,
open bypass presents a dual risk. The necessary anticoagulation therapy has hemorrhagic complications,
and endovascular treatment itself is associated with embolic complications. When considering these
points, open surgery does appear to be beneficial, because treatment is completed by 1 surgery.

Open Bypass
Microsurgical cerebral revascularization techniques have been used in some studies to prevent post-PAO
ischemic complications [3, 4, 15, 24]. Chang et al. discussed the risk of bypass and stated that in cases of
aneurysms of the distal PCA, clinicians should limit the number of bypasses by improving patient
selection (via balloon test occlusion [BTO], stent-coiling, and assessing the patient’s neurological status)
[5]. BTO in the PCA is technically challenging, but it is feasible. Bypassed flow can only contribute to
the prevention of visual field loss. Because it is unclear whether bypass flow contributes to the perforating
artery, the problem of thalamic infarction associated with PAO in the P2 segment remains unresolved.
Moreover, the bypass procedure itself may interfere with the collateral anastomosis. On the other hand,
visual field loss is severely debilitating and may limit many normal activities in daily life, such as driving.
Thus, sufficient investigation into the risks and benefits of the method is important in determining a
therapeutic policy. For the use of bypass to be feasible, the rate of complications and the incidence of
visual field loss must be lower than that in interventions without bypass. Use of bypass must be limited to
patients with good neurological status. Usually, anticoagulation therapy is necessary during endovascular
procedures, to prevent embolic complications. Under anticoagulation therapy, the risk of perioperative

7

bleeding (epidural hematoma, subdural hematoma, and bleeding from the anastomosis) associated with
the open bypass procedure may be high. For these reasons, open bypass to prevent ischemic
complications caused by PAO does not provide any benefit. In the future, stent coiling to preserve the
parent artery will play an important role in this anatomical region, including the treatment of giant
aneurysms in the P1 segment. However, the results of long-term follow-up after this procedure remain
unclear.

Conclusions
Intra-aneurysmal embolization is a good treatment for saccular aneurysms with well-defined necks. PAO
should be performed in cases of SAH where SOA cannot be performed safely. Although the PCA is rich
in collateral circulation, cerebral infarctions were noted in most patients after PAO, and it was difficult to
predict the occurrence of these infarctions. However, the area of cerebral infarction tended to be small,
and the neurological deficits observed were not critical. These findings suggest that PAO is a rather safe
procedure for aneurysms of the P2 segment, and that SOA cannot be safely performed at a site distal to
the P2 segment. Bypass techniques are used to prevent post-PAO ischemic complications. The rate of
complications and the incidence of visual field loss must be lower than those in interventions without
bypass. The use of bypass must be limited to patients with good neurological status. To determine the
therapeutic policy for the use of bypass, it is necessary to obtain sufficient data about the risks and
benefits of the method.

Conflict of interest
The authors declare that they have no conflict of interes

8

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large-giant or fusiform distal posterior cerebral artery aneurysms. Neuroradiology 44:700-705

(2) Biondi A, Jean B, Vivas E, Le Jean L, Boch AL, Chiras J, Van Effenterre R (2006) Giant and large
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(9) Drake CG, Amacher AL (1969) Aneurysms of posterior cerebral artery. J Neurosurgery 30:468-474

(10) Drake CG, Peerless SJ, Hernesniemi JA (1996) Surgery of vertebrobasilar aneurysms: London,
Ontario, experience on 1767 patients. Springer, New York, pp 221-248

(11) Ferrante L, Acqui M, Trillò G, Lunardi P, Fortuna A (1996) Aneurysms of the posterior cerebral
artery: do they present specific characteristics? Acta Neurochir (Wien) 138:840-852

9

(12) Gerber CJ, Neil-Dwyer G, Evans BT (1993) An alternative surgical approach to aneurysms of the
posterior cerebral artery. Neurosurgery 32:928-931

(13) Hallacq P, Piotin M, Moret J (2002) Endovascular occlusion of the posterior cerebral artery for the
treatment of p2 segment aneurysms: retrospective review of a 10-year series. Am J Neuroradiol
23:1128-1136

(14) Hamada J, Morioka M, Yano S, Todaka T, Kai Y, Kuratsu J (2005) Clinical features of aneurysms of
the posterior cerebral artery: a 15-year experience with 21 cases. Neurosurgery 56:662-670

(15) Kocaeli H, Chaalala C, Abruzzo TA, Zuccarello M (2009) Results of surgical management for
posterior cerebral artery aneurysms: 7-year experience in the endovascular era. Acta Neurochir (Wien)
151:1583-1591

(16) Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R (2002)
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. Lancet 360:1267-1274

(17) Purkayastha S, Gupta AK, Krishnamoorthy T, Bodhey NK (2006) Endovascular treatment of
ruptured posterior circulation dissecting aneurysms. J Neuroradiol 33:329-337

(18) Roh HG, Kim SS, Han H, Kang HS, Moon WJ, Byun HS (2008) Endovascular treatment of posterior
cerebral artery aneurysms using detachable coils. Neuroradiology 50:237-242

(19) Sakata S, Fujii K, Matsushima T, Fujiwara S, Fukui M, Matsubara T, Nagatomi H, Kuromatsu C,
Kamikaseda K (1993) Aneurysm of the posterior cerebral artery: report of eleven cases–surgical
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(23) van Rooij WJ, Sluzewski M, Beute GN (2006) Endovascular treatment of posterior cerebral artery
aneurysms. Am J Neuroradiol 27:300-305

(24) Vishteh AG, Smith KA, McDougall CG, Spetzler RF (1998) Distal posterior cerebral artery
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11

Figure Legends
Fig. 1
A magnetic resonance (MR) image showed a subarachnoid hemorrhage. Cerebral angiography revealed a
large aneurysm of the left P2 segment. The patient underwent parent artery occlusion of the P2 segment
directly proximal to the aneurysm; the technique was performed using a detachable coil. Radiographically,
the aneurysm was occluded, and leptomeningeal collateral circulation was observed. Postoperative MR
image showed cerebral infarction in the thalamus and occipital lobe

Fig. 2
Postoperative computed tomography image showed a large cerebral infarction in the occipital lobe.
Cerebral angiography revealed a small aneurysm of the right P3 segment. Parent artery occlusion using a
detachable coil was performed immediately proximal to the aneurysm. Radiographically, the aneurysm
was occluded, and leptomeningeal collateral circulation was observed

Fig. 3
Angiogram showing a large saccular aneurysm in the P1–2 segment. Selective occlusion of aneurysm
Complete occlusion was noted after SOA using a detachable coil. Three months after the treatment,
oculomotor palsy had disappeared.

12

No/Age/Sex clinical presentation Site Aneurysm type
1/64/M
incidental
P4 fusiform
2/56/F
incidental
P1-2 saccular
3/58/F
SAH HK IV
P4 saccular
4/57/F
incidental
P1-2 saccular
5/74/F
CN III palsy
P1-2 saccular
6/66/F
SAH HK I
P2 thrombosed
7/69/F
SAH HK IV
P3 berry
8/65/F
SAH HK IV
P1 saccular
9/57/M
SAH HK II
P2 saccular
10/58/F
SAH HK II
P1 saccular
11/54/F
SAH HK I
P3 thrombosed
12/68/F
SAH HK IV
P1 saccular
13/64/F
SAH HK III
P2 saccular
14/66/F
incidental
P2 saccular
15/77/F
SAH HK II
P2-3 saccular
16/33/M
incidental
P1-2 saccular
17/61M
SAH HK I
P2 dissection
18/49/M
SAH HK I
P2-3 saccular
19/78/F
SAH HK III
P2-3 saccular
20/62/M
SAH+ICH HK III
P4 saccular
21/43/M
SAH HK IV
P2-3 thrombosed
Table1 Summary of 21 patients

Size
large
small
small
small
large
large
small
large
large
small
large
small
small
small
small
small
small
small
small
small
giant

Intervention Outcome
PAO
no deficit
IAE
no deficit
PAO
GOS4 hemianopsia
IAE
no deficit
IAE
no deficit
PAO
GOS4 hemianopsia+numbness
PAO
GOS3
IAE
GOS2
PAO
GOS5
IAE
GOS5
PAO
GOS5
IAE
GOS5
IAE
GOS4
IAE
no deficit
IAE
GOS5
IAE
no deficit
PAO
GOS4
IAE
GOS5 , retreatment
IAE
GOS4
PAO
GOS3
PAO
GOS1

infarction

Associated disease

occipital (small)

thalamus+occipital (small)
occipital (large)
occipital (small)
occipital (small)
MoyaMoya

BAVM
occipital (small)

dAVF
occipital (small)

Author
Age/Sex clinical presentation
Rooij et.al 43/F
incidental
Rooij et.al 64/M
SAH
Rooij et.al 32/M
SAH
Rooij et.al 27/M
SAH
Rooij et.al 64/F
SAH
Xianli et al 37/F
SAH
Xianli et al 49M
headache+hemiparesis
Xianli et al 43M
headache+heminumbness
Xianli et al 48M
SAH+CNIII
Xianli et al 58F
ICH
Xianli et al 31M
SAH
Xianli et al 4/M
headache
Xianli et al 5/M
SAH
Ciceri et al 21/F
?
Ciceri et al 12/M
SAH
Ciceri et al 52/F
SAH
Ciceri et al 58/M
memory loss
Ciceri et al 52/F
SAH
Ciceri et al 56/F
?
Ciceri et al 57/M
?
Hallacq et al 20/M
headache
Hallacq et al 60M
headache
Hallacq et al 49F
Gerstman syndrome
Hallacq et al 49F
headache
Hallacq et al 47M
SAH
Hallacq et al 26M
headache
Arat et al
52/M
SAH
Arat et al
17/M
headache+hemiparesis
Arat et al
23/M
headache
Arat et al
51/M
headache
Arat et al
48/M
SAH
Arat et al
26/F
headache
Arat et al
23/M
headache
Arat et al
61/M
SAH
Biondi et al 28/F
headache
Biondi et al 34/M
headache
Biondi et al 25/F
ICH,hemiplegia
Biondi et al 50M
headache,visual trouble

Site
P2
P2
P2-3
P4
P4
P2
P2
P2
P2
P2
P2
P2
P2
P1
P2
P2-3
P2-3
P2-3
P3
P3
P2
P2
P2
P2
P2
P2
P2
P2
P2
P2-3
P2
P2
P3
P2
P2-3
P2-3
P2
P2

Aneurysm type
Fusiform
Fusiform,Dissection
Dissection
Mycotic
Saccular
Dissection
Dissection
Dissection
Dissection
Dissection
Dissection
Dissection
Dissection
serpentine
serpentine
Berry
serpentine
Berry
serpentine
serpentine
Fusiform
Fusiform
Fusiform thrombosed
Saccular
Fusiform
serpentine thrombosed
Saccular
Fusiform
Saccular
Fusiform
Saccular
Fusiform
Fusiform
Saccular
forcal dilatation,thrombosed
focal dilatation,thrombosed
focal dilatation
focal dilatation

Size
small
large
large
small
small
small
large
large
large
small
large
large
large
giant
giant
small
giant
small
giant
giant
large
large
giant
large
giant
giant
large
?
giant
?
large
?
?
large
giant
giant
giant
large

Intervention
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO with aneurysm
PAO without aneurysm
PAO without aneurysm
PAO without aneurysm
PAO without aneurysm

Table2 The summary of the patients treated by PAO using bare metal coils in literature review

Outcome
Associated disease
GOS5
GOS5
GOS1
GOS1
AIDS,endocarditis
GOS4
GOS5
GOS4
GOS5
GOS5
GOS4
GOS5
GOS5
GOS5
GOS5
GOS5
GOS5 hemianopsia
GOS5 hemianopsia+hemiparesis
GOS5
GOS5
GOS5
GOS5
GOS5
GOS5
GOS5
GOS5
GOS5
GOS4 hemianopsia+occpital infarction
GOS5
GOS5
GOS5 posterior thalamus infarction temporary hemiparesis hyperaesthesia
GOS5 posterior thalamus infarction
GOS5
GOS5
GOS5
GOS5
GOS5
GOS3 partial hemianopsia
GOS4