Tanabe J, et al. - Researchers aimed at assessing the impact of right-sided aneurysm, rupture status, and size of aneurysm on perforator infarction following microsurgical clipping of posterior communicating artery aneurysms with a distal transsylvian approach. In this study, ruptured status, right side, and large posterior communicating artery (PCoA) aneurysm were identified as independent predictors of PCoA perforator infarction. PCoA perforating infarction related symptoms were mostly transient and rarely affected outcomes.

Methods

• PCoA aneurysm clipping, excluding application of fenestrated clips, was performed on a total of 183 patients.
• Two groups of the patients were formed: patients with PCoA perforator infarction (infarction group), and patients without infarction (non-infarction group).
• The groups were analyzed for multiple factors.

Results

• Perforator infarction was identified in 22 of the 183 patients (12.0%); magnetic resonance imaging evaluation revealed majority of the infarctions.
• In two patients (1.1%), the infarctions resulted in permanent deficits .
• The infarction group had significantly higher proportion of right-sided operations (86.4% vs 53.4%; P=0.005) and surgery for rupture (90.9% vs 55.9%; P=0.002) than in the non-infarction group.
• In the infarction group, aneurysms were significantly larger (8.4±3.8 mm) than in the non-infarction group (6.3±3.0 mm; P=0.02).
• On multivariate logistic regression analysis, ruptured status (odds ratio (OR), 7.35; P=0.01), right side (OR, 5.19; P=0.01), and aneurysm size (OR, 1.18; P=0.02) continued to be the independent predictors of perforator infarction.