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Vol. 20. Issue 3.
Pages 288-293 (January 2009)
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Vol. 20. Issue 3.
Pages 288-293 (January 2009)
DOI: 10.1016/S1130-1473(09)70171-X
Bilateral paramedian thalamic and mesencephalic infarcts after basilar tip aneurysm coiling: role of the artery of Percheron
Infarto talámico paramedial bilateral y mesencefálico después del tratamiento endovascular de un aneurisma de la punta de la arteria basilar: rol de la arteria de Percheron
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L. Rangel-Castilla??, J. Gasco, B. Thompson, P. Salinas
Division of Neurosurgery. University of Texas Medical Branch (UTMB). Galveston. Texas
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Summary

Aneurysm embolization using Guglielmi detachable coils (GDC) is gaining acceptance as a viable alternative for surgery in the treatment of aneurysms. Recent reports describe a significant rate of thromboembolic complications. Thalamic and midbrain blood supply can arise from complex anatomical variations. The rare variation: “artery of Percheron”, is a solitary arterial trunk arising from one of the proximal segments of a posterior cerebral artery and supplies the paramedian thalami and rostral midbrain bilaterally. We describe a patient that underwent elective endovascular treatment for a basilar tip aneurysm using GDC and stents in each PCA; 12 hours later patient was comatose and not following commands. Sequential magnetic resonance imaging (MRI) of brain showed bilateral paramedian thalamic and mesencephalic infarcts presumably secondary to artery of Percheron occlusion. Thromboembolic event related to the use of the GDC embolization and stents is a rare clinical sequelae, but catastrophic. The use of antiplatelets agents should be reinforced in the scenario. When bilateral medial thalamic and midbrain infarcts are found, occlusion of the artery of Percheron should be considered. Angiography may not b helpful and lack of visualization of the artery does not exclude its presence. In this case the MRI findings confirmed the presence of the infarction based on the anatomical distribution.

Key words:
Endovascular treatment
Coiling
Basilar tip aneurysm
Bilateral paramedian thalamic and mesencephalic infarcts
Artery of Percheron
Resumen

La técnica endovascular para el manejo de aneurismas está ganando auge como una alternativa a la cirugía abierta. Sin embargo, se han descrito diferentes complicaciones tromboembólicas relacionadas con esta modalidad. El flujo sanguíneo al tálamo y al mesencéfalo puede surgir de variaciones anatómicas complejas. La variación infrecuente: “arteria de Percheron”, es una rama arterial solitaria que se origina del segmento proximal de una de la arterias cerebrales posteriores.

Presentamos un paciente que tuvo un procedimiento endovascular electivo para el tratamiento de un aneurisma de la punta de la arteria basilar; 12 horas después del procedimiento, el paciente estaba clínicamente en coma profundo. La resonancia magnética (RM) cerebral mostró infartos talámicos paramediales bilaterales y mesencefálicos, compatible con la oclusión de la arteria de Percheron.

Los eventos tromboembólicos relacionados con el uso de embolización con coil y stents es una rara pero catastrófica secuela. El uso de agentes antiplaquetarios se debe de recomendar en este tipo de situaciones. Cuando existen infartos talámicos paramediales bilaterales y mesencefálicos, la oclusión de la arteria de Percheron se debe de tener en mente. La angiografía puede no ser de mucha utilidad y la falta de visualización de la arteria no excluye su presencia. En este caso los hallazgos en la RM cerebral confirman la presencia de un infarto basado en la distribución anatómica de la arteria de Percheron.

Palabras clave:
Endovascular
Coil
Aneurisma cerebral
Arteria basilar
Infarto talámico paramediano bilateral y mesencefálico
Arteria de Percheron

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