BACKGROUND AND OBJECTIVES In ruptured posterior communicating artery (PcomA) aneurysms, the protection of the aneurysm dome alone with initial subtotal coiling decreases the risk of rerupture in the acute setting but does not provide durable/definitive long-term protection against delayed rupture. Delayed flow diverter (FD) placement can be a potential alternative to definitively secure these aneurysms without increasing the risk of complications and PComA occlusion. We analyzed PComA aneurysms treated with a planned delayed FD after primary coiling and assess radiographic and clinical outcomes. METHODS We performed a retrospective study of prospectively collected data for intracranial aneurysms treated with planned FD at 2 institutions from 2013 to 2022. PComA aneurysms that underwent primary coiling and delayed FD placement were included for analysis. RESULTS There were 29 PComA aneurysms identified that were included in the analysis. Patients were mostly female (79.3%), with a median age of 60 years. The mean aneurysm maximum diameter was 7.2 mm ± (5.3). Immediate Raymond-Roy occlusion grade after primary coiling was I in 48.3%, II in 41.4%, and III in 10.3% of aneurysms. The median time from initial coiling to planned delayed FD placement was 6.3 months (3.2-18.6). A total of 21 (72.4%) aneurysms underwent follow-up radiological imaging. Complete and near-complete occlusion status was achieved in 76.2% of the evaluated aneurysms. There were no retreatments and no evidence of delayed aneurysm rupture. One case (3.5%) presented thromboembolic complications and 1 (3.5%) intracranial hemorrhagic complication after FD placement, which was associated with mortality. Most patients (90.5%) had a modified Rankin scale of ≤2 on the last follow-up. CONCLUSION Primary coiling with planned staged FD placement is effective for treating ruptured PComA aneurysms with high occlusion rates and low complications.

中文翻译：

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急性盘绕延迟血流转移治疗后交通段颈内动脉瘤：多中心病例系列。

背景和目的在破裂的后交通动脉（PcomA）动脉瘤中，仅通过初始次全弹簧圈保护动脉瘤穹顶可降低急性情况下再破裂的风险，但不能提供持久/明确的长期保护以防止延迟性破裂。延迟分流器 (FD) 放置可能是一种潜在的替代方案，可明确固定这些动脉瘤，而不会增加并发症和 PComA 闭塞的风险。我们分析了初次弹簧圈栓塞后按计划延迟 FD 治疗的 PComA 动脉瘤，并评估了影像学和临床结果。方法 我们对 2013 年至 2022 年在 2 家机构前瞻性收集的计划 FD 治疗的颅内动脉瘤数据进行了回顾性研究。对接受一期弹簧圈栓塞和延迟 FD 放置的 PComA 动脉瘤进行了分析。结果 分析中包含了 29 个 PComA 动脉瘤。患者大多为女性（79.3%），中位年龄为 60 岁。平均动脉瘤最大直径为 7.2 mm ± (5.3)。初次弹簧圈栓塞后即刻 Raymond-Roy 闭塞等级为 I（48.3%）、II（41.4%）和 III（10.3%）。从最初盘绕到计划延迟 FD 放置的中位时间为 6.3 个月 (3.2-18.6)。总共 21 个（72.4%）动脉瘤接受了随访放射学成像。76.2% 的评估动脉瘤达到完全和接近完全闭塞状态。没有进行再治疗，也没有延迟性动脉瘤破裂的证据。FD 放置后 1 例（3.5%）出现血栓栓塞并发症和 1 例（3.5%）颅内出血并发症，与死亡率相关。大多数患者（90.5%）在最后一次随访时改良Rankin量表≤2。结论 初次弹簧圈弹簧栓塞结合计划的分期 FD 放置可有效治疗破裂的 PComA 动脉瘤，且闭塞率高且并发症低。