Individualized endovascular management of distal posterior circulation aneurysms: a single-center experience and decision framework.

Purpose: Distal intracranial aneurysms (IAs) of the posterior circulation are rare and often pose significant surgical challenges. Although endovascular treatment (EVT) has emerged as an alternative, clear management guidelines remain lacking. We report a single-center experience with EVT for these complex lesions, focusing on procedural outcomes, complications, and follow-up results. Methods: We retrospectively reviewed patients with distal posterior circulation IAs who underwent EVT at our institution between January 2017 and December 2024. Treatment strategies were individualized based on aneurysm morphology, vascular access tortuosity, parent artery (PA) caliber, distal collateral circulation, and the functional importance of the PA territory. Outcomes assessed included technical success, perioperative complications, angiographic occlusion, and clinical status at the last follow-up, as measured by the modified Rankin Scale (mRS). Results: Nineteen patients (10 men, 9 women; median age 58 years) with 19 aneurysms were included. Aneurysm locations were posterior cerebral artery ( Conclusion: For surgically intractable distal posterior circulation aneurysms, EVT represents a viable alternative. Individualized treatment strategies should be formulated according to aneurysm characteristics, vascular access tortuosity, parent artery caliber, distal collateral perfusion, and whether the PA supplies eloquent brain territories. Appropriate individualized management can yield favorable clinical outcomes in the majority of patients.