Posterior cerebral artery dissection: clinical and angiographic spectrum, management, and outcomes in a retrospective 14-patient case series

Posterior cerebral artery (PCA) dissection is a rare cerebrovascular disorder with heterogeneous clinical and angiographic presentations. Because evidence is largely limited to small case series and individual reports, optimal diagnostic and therapeutic strategies remain uncertain. We retrospectively reviewed 14 patients with angiographically confirmed PCA dissection or dissecting PCA aneurysms identified at a single center between January 2016 and December 2025. Clinical presentation, angiographic characteristics, treatment strategy, procedural complications, and available clinical and vascular imaging follow-up were analyzed. The median age was 43.5 years (IQR, 33.8–56.3; range, 20–63 years). Hemorrhagic presentation occurred in 8 patients (57.1%), including 6 with subarachnoid hemorrhage (42.9%). Two patients were managed conservatively, 3 underwent conventional stenting alone, 5 underwent flow-diverter treatment, 2 underwent coil embolization without an implanted stent, and 2 underwent conventional stenting combined with coil embolization. Most patients achieved favorable clinical and angiographic outcomes. One patient remained severely disabled (mRS 5), and one patient developed fatal post-procedural subarachnoid hemorrhage after flow-diverter treatment. PCA dissection is a rare and clinically heterogeneous condition that may present with hemorrhagic or nonhemorrhagic manifestations. Management should be individualized according to rupture status, lesion morphology, vascular anatomy, collateral circulation, and the feasibility of parent-vessel preservation. Conservative management and different endovascular strategies may be appropriate in selected patients, but the small retrospective nature of available series precludes conclusions regarding superiority of any single treatment approach.