A Case of Fetal-Type Posterior Communicating Artery Aneurysm Suffered from Thromboembolic and Perforator Occlusion after Flow Diverter Therapy

Flow diverter placement for fetal-type posterior communicating artery (PCom) aneurysms is known to result in a low complete occlusion rate due to the tendency for flow out toward the PCom, resulting in residual blood flow within the aneurysm. Here, we report a case of ischemic complications after flow diverter treatment for a fetal-type PCom bifurcation aneurysm. Seventy-five-year-old woman had unruptured left fetal-type PCom. Pipeline placement with coils was performed. Eight months after surgery, the patient developed transient paralysis of the right and left lower extremities due to scattered embolic ischemic complications in the perfusion area of the fetal PCom after reducing the antiplatelet medication dose. Tight packing was performed within the aneurysm from P1 via the PCom. Transient paralysis of the right upper and lower extremities was observed due to acute infarction in the tuberothalamic artery region after operation. Flow diverter placement for fetal-type PCom aneurysms is difficult to achieve complete occlusion, and when aiming for complete occlusion, it is necessary to consider the risk of ischemic complications in the tuberothalamic artery.