The need for revascularization with proximal posterior cerebral artery occlusion in
the treatment of giant and fusiform aneurysms is unclear. While early series demonstrated
only about a 10% chance of infarction following posterior cerebral artery occlusion,
recently several authors have advocated a bypass prior to parent vessel sacrifice
in all cases. We present the case of an adult man with a fusiform aneurysm of the
right posterior cerebral artery at the P2-P3 junction. He clinically failed a balloon
test occlusion preoperatively and therefore underwent an occipital artery to distal
posterior cerebral artery bypass with subsequent endovascular occlusion of the parent
vessel and aneurysm. Despite the fact that the immediate and 6 month follow up cerebral
angiography confirmed a patent bypass, the patient still developed a posterior cerebral
artery territory stroke. We believe this case demonstrates that successful distal
revascularization in the setting of proximal posterior cerebral artery occlusion does
not guarantee against cerebral ischemia and infarction even in those patients that
fail a test occlusion.
Key-words:
Cerebral aneurysms - revascularization - stroke
