The Effectiveness of Different Endovascular Treatments for Pcoma Aneurysms in the Presence of a Fetal Variant

Introduction: The optimal management for PcomA aneurysms with Fetal PCA remains to be determined due to the limited data available, as this is a rare subtype. Our study aims to investigate the safety and effectiveness of different endovascular techniques in treating PcomA aneurysms associated with a fetal PCA.

Methods: To extract data on patients with fPCA who were treated by endovascular embolizations, a 12-year retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) was conducted between 2013 and 2024. Follow-up occlusion outcomes were evaluated using the RROC (Raymond-Roy Occlusion Classification).

Results: Our study included 40 patients from the STAR registry treated with different endovascular modalities. The average age of the patients was 58.13(12.25), and the male-to-female ratio was 0.38. There was a significant difference between the treatment type and the occlusion rate (P < 0.001). All the patients who were treated with a stent had an occluded aneurysm on follow-ups. Coiling, which was mainly used in ruptured aneurysms (88.89%), was the most prevalent treatment that needed retreatment (45.5%). Patients' short- and long-term outcomes were similar regardless of treatment type. The fetal patency was intact in all the cases on follow-up.

Conclusion : The effectiveness of endovascular embolization of PcomA aneurysms in the presence of a fetal variant is controversial. In our study, stent-assisted coiling demonstrated successful short- and long-term occlusion.