1055. Comparison of Management Strategies for Fetal Posterior Communicating Artery Aneurysms

Authors: Yasmeen Elsawaf; Robert Rennert, MD; David Santiago-Dieppa, MD; Jeffrey Steinberg, MD; Arvin Wali, MD; Scott Olson, MD; J Pannell, MD; Alexander Khalessi, MD (Orlando, FL)

Introduction:

Fetal posterior communicating artery (PCOM) aneurysms have increased recurrence rates due to the high adjacent flow of the fetal variant circulation. Current management techniques of fetal PCOM aneurysms include endovascular coiling +/- stenting, flow diversion, and surgical clipping. This study analyzes the treatment outcomes of fetal PCOM aneurysms by technique.

Methods:

Retrospective review of a single-institution prospective database was conducted between March 2013 to April 2018 to identify patients with fetal PCOM aneurysms treated with coiling +/- stenting, flow-diversion, surgical clipping, or a combination of techniques. Angiographic occlusion/reoccurrence rates, peri-operative hemorrhage, and neurologic outcomes were recorded.

Results:

15 patients with fetal PCOM aneurysms were included in the study (8 ruptured/7 unruptured). 9 patients underwent initial treatment with coil embolization alone, with a 66.7% (n=6/9) median recurrence rate requiring repeat intervention. 3 patients underwent an initial combined treatment with stent placement and coil embolization, with a 0% median recurrence rate. 1 patient underwent an initial combined treatment with flow diversion/coil embolization, with a 0% median recurrence rate. 2 patients underwent surgical clipping, with a recurrence rate of 0%. Median follow up time was 7.5 months (range: 3 to 12 months). Glasgow Outcome Scale score at follow-up was a median of 5 for all interventions (range: 3 to 5).

Conclusions:

Fetal PCOM aneurysms have an increased risk of recurrence with coiling alone. Combined stenting or flow diversion with coiling, or open surgical management may be considered to decrease recurrence risk in this patient subset.