“True” Aneurysm of the Posterior Communicating Artery as a Possible Effect of Collateral Circulation in a Patient with Occlusion of the Internal Carotid Artery. A Case Study and Literature Review

Abstract

“True” posterior communicating artery (PCoA) aneurysms are extremely rare. A case of a 63-year-old patient with a ruptured “true” aneurysm of the right PCoA associated with the occlusion of the right internal carotid artery is presented. For nine years before he suffered from subarachnoid hemorrhage, the patient had developed symptoms of transient ischemic attack (TIA) due to the occlusion of the right internal carotid artery. The left vertebral angiogram demonstrated a “true” right PCoA aneurysm and collateral flow from the right posterior communicating artery to the right internal carotid artery. The right internal carotid system was also fed by collateral circulation from the left carotid artery through the anterior communicating artery. Transcranial colour-coded real-time sonography (TCCS) demonstrated increased velocity and turbulent blood flow in both communicating arteries. The patient was operated on and the aneurysm was clipped successfully. This case report suggests that the blood flow disturbances resulting from the collateral circulation through the PCoA could be a conductive factor in the formation and development of the aneurysm. This is the first described case of a “true” aneurysm of the PCoA coexistent with the occlusion of the internal carotid artery.

Key words

“True” Posterior Communicating Artery Aneurysm - Transcranial Colour-Coded Real-Time Sonography - Carotid Occlusion - Aneurysm Development

References

• 1 Akimura T, Abiko S, Ito H. True posterior communicating artery aneurysm.  Acta Neurol Scand. 1991;  84 207-209
• 2 Krayenbühl H A, Yasargil G, Flamm E S, Tew J M. Microsurgical treatment of intracranial saccular aneurysms.  J Neurosurg. 1972;  37 678-686
• 3 Kudo T. An operative complication in a patient with a true posterior communicating artery aneurysm: Case report and review of the literature.  Neurosurgery. 1990;  27 650-653
• 4 Yoshida M, Watanabe M, Kuramoto S. “True” posterior communicating artery aneurysm.  Surg Neurol. 1979;  11 379-381
• 5 Timothy J, Sharr M, Doshi B. Perils of a “true” posterior communicating artery aneurysm.  Br J Neurosurg. 1995;  9 789-791
• 6 Jaffe M E, McHenry L C. Cerebral aneurysm following spontaneous carotid occlusion.  Neurology. 1968;  18 1012-1014
• 7 Kawamura S, Yoshida T, Nonoyama Y, Yamada M, Suzuki A, Yasui N. Ruptured anterior spinal artery aneurysm: a case report.  Surg Neurol. 1999;  51 608-612
• 8 Ushikoshi S, Houkin K, Itoh F, Saitoh H, Nozaki M, Kuroda S, Abe H. Ruptured aneurysm of the middle meningeal artery associated with occlusion of the posterior cerebral artery. Case report.  J Neurosurg. 1996;  84 269-271
• 9 Yamanaka C, Hirohata T, Kiya K, Yoshimoto H, Uozumi T. Basilar bifurcation aneurysm associated with bilateral internal carotid occlusion.  Neuroradiology. 1987;  29 84-88
• 10 Dyste G N, Beck D W. De novo aneurysm formation following carotid ligation: case report and review of the literature.  Neurosurgery. 1989;  24 88-92
• 11 Hashimoto N, Handa H, Nagata I, Hazama F. Experimentally induced cerebral aneurysms in rats: Part V. Relation of hemodynamics in the circle of Willis to formation of aneurysms.  Surg Neurol. 1980;  13 41-45
• 12 Hassler O. Experimental carotid ligation followed by aneurysmal formation and other morphological changes in the circle of Willis.  J Neurosurg. 1963;  20 1-7
• 13 Hazama F, Kataoka H, Yamada E, Kayembe K, Hashimoto N, Kojima M, Kim C h. Early changes of experimentally induced cerebral aneurysms in rats. Light-microscopic study.  Am J Pathol. 1986;  124 399-404
• 14 Maiuri F, Spaziante R, Iaconetta G, Signorelli F, Cirillo S, di Salle F. “De novo” aneurysm formation: report of two cases.  Clin Neurol Neurosurg. 1995;  97 233-238
• 15 Alpers B J, Schlezinger N S. Aneurysm of the posterior communicating artery.  Arch Ophthalmol. 1949;  42 353-364
• 16 Madow L, Alpers B J. Aneurysm of the posterior communicating artery. Report of five additional cases.  Arch Neurol Psychiatry. 1953;  70 722-732
• 17 Soni S R. Aneurysms of the posterior communicating artery and oculomotor paresis.  J Neurol Neurosurg Psychiatr. 1974;  37 475-484
• 18 Pedroza A, Dujovny M, Artero Cabezudo J, Umansky F, Berman Kim S, Diaz F G. et al . Microanatomy of the posterior communicating artery.  Neurosurgy. 1987;  20 228-235
• 19 Saeki N, Rhoton A L. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis.  J Neurosurg. 1977;  46 563-578
• 20 Ładzin|'ski P, Koper R, Maliszewski M, Majchrzak H. Views on the aetiology and pathogenesis of intracranial saccular aneurysms.  Neur Neurochir Pol. 1996;  30 649-657
• 21 Mabuchi S, Kamiyama H, Abe H. Distal aneurysms of the superior cerebellar artery and posterior inferior cerebellar artery feeding an associated arteriovenous malformation: Case report.  Neurosurgery. 1992;  30 284-287
• 22 Sasaki T, Kodama N, Itokawa H. Aneurysm formation and rupture at the site of anastomosis following bypass surgery. Case report.  J Neurosurg. 1996;  85 500-502
• 23 Stehbens W E. Etiology of intracranial berry aneurysms.  J Neurosurg. 1989;  70 823-831
• 24 Holzschuh M, Woertgen Ch, Brawanski A. Transcranial Doppler sonography in a patient with Ehlers-Danlos syndrome: Case report.  Neurosurgery. 1996;  39 170-173
• 25 Stehbens W E, Delahunt B, Hilless A. Early berry aneurysm formation in Marfan's syndrome.  Surg Neurol. 1989;  31 200-202
• 26 Wright R L, Sweet W H. Carotid or vertebral occlusion in the treatment of intracranial aneurysms; value of early and late readings of carotid and retinal pressures.  Clin Neurosurg. 1962;  9 163-192
• 27 Fujiwara S H, Fijii I, Fukui M. De novo aneurysm formation and aneurysm growth following therapeutic carotid occlusion for intracranial internal carotid artery (ICA) aneurysms.  Acta Neurochir. 1993;  120/1 - 2 20-25
• 28 Bisaria K K. Anomalies of the posterior communicating artery and their potential clinical significance.  J Neurosurg. 1984;  60 572-576