Management and Follow-Up of a Distal PCA Aneurysm: A Case Report of Initial Success and Subsequent Challenges

Posterior Cerebral Artery (PCA) aneurysms, rare intracranial anomalies, present significant treatment challenges due to their complex anatomy and proximity to delicate structures, with an occurrence rate of about 0.7-2.2%. These aneurysms affect a younger population, averaging 38 years, compared to 50-60 years for other intracranial aneurysms. This location has a higher incidence of giant aneurysms (23% versus 3–5% elsewhere), and 80% of cases develop Subarachnoid Hemorrhage (SAH). Wide neck PCA aneurysms are challenging to treat and are less suitable for coiling or surgical clipping, requiring additional endovascular devices or complete artery occlusion for full aneurysm exclusion. This case underscores the complexities of distal PCA aneurysms and emphasizes the benefits of endovascular devices like flow diverter stents and parent artery occlusion, as PCA preservation is not critical in distal aneurysms.