{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:56:00Z","timestamp":1788389760298,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) involves a sudden onset of a perfusion-pressure injury from the initial insult combined with a secondary injury phase produced by delayed cerebral ischemia, cerebrospinal fluid circulation disturbances, and generalized instability of the patient\u2019s physiological state. The situation may be further complicated when there has been rupture of the aneurysm at the site of the carotid\u2013posterior communicating (PCom) artery junction that occurs in conjunction with a fetal configuration of the posterior cerebral artery (fPCA), thereby making definitive treatment dependent on preserving the critical nature of the branches of the posterior circulation since the aneurysm\u2019s neck plane coincides with the dominant posterior circulation conduit. Case Presentation: A 65-year-old female patient who was obese (Grade III BMI = 42), had chronic bronchial asthma, and arterial hypertension experienced a \u201cthunderclap\u201d type of headache in the right retro-orbital area followed by a syncopal episode and developed acute confusion with agitation. Upon admission to the hospital, her Glasgow Coma Scale (GCS) was 13, her FOUR score was 15, her Montreal Cognitive Assessment (MoCA) score was 12\/30, her Hunt\u2013Hess grade was 3, WFNS grade 2, and Fisher grade 4 SAH with intraventricular extension. Digital subtraction angiography (DSA) and three-dimensional rotational angiography revealed a posteriorly directed right carotid communicating aneurysm that had a relatively compact neck (approximately 2.5 mm) and sac size of approximately 7.7 \u00d7 6.6 mm, with the fPCA originating at the neck plane. Microsurgical treatment was performed with junction-preserving reconstruction with skull base refinement, temporary occlusion of the internal carotid artery for a few minutes, placement of clips reconstructing the carotid\u2013PCom interface, and micro-Doppler verification of patent vessel. Postoperatively, the blood pressure was kept within the range of 110\u2013130 mmHg with nimodipine and closely monitored. The neurological recovery was sequential (GCS of 15 by POD 2; MoCA of 22 by POD 5). By POD 5 CT scan, the clip remained positioned in a stable fashion without evidence of infarct, hemorrhage, or hydrocephalus; at three months she was neurologically intact (mRS 0; Barthel 100; MoCA 28\/30), and CTA confirmed persistent exclusion of the aneurysm and preservation of fPCA flow. Conclusions: In cases where the ruptured aneurysm is located at the carotid communicating junction with the PCom artery in a configuration of the posterior cerebral artery that is described as fetal, clip treatment should be viewed as a form of branch-preserving junction reconstruction of the carotid\u2013PCom junction supported by adherence to controlled postoperative physiology and close ppostoperativesurveillance.<\/jats:p>","DOI":"10.3390\/diagnostics16020307","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:57:02Z","timestamp":1768816622000},"page":"307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Branch-Critical Clipping of a Ruptured Carotid\u2013Posterior Communicating Aneurysm with Fetal PCA Configuration"],"prefix":"10.3390","volume":"16","author":[{"given":"Catalina-Ioana","family":"Tataru","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Opthamology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Central Military Emergency Hospital \u201cDr. Carol Davila\u201d, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9043-3690","authenticated-orcid":false,"given":"Cosmin","family":"Pantu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Breazu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix-Mircea","family":"Brehar","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matei","family":"Serban","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan-Adrian","family":"Covache-Busuioc","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corneliu","family":"Toader","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mugurel Petrinel","family":"Radoi","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Vasile","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Pathology, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Stragier, H., Vandersmissen, H., Ordies, S., Thiessen, S., Mesotten, D., Peuskens, D., and Ten Cate, H. (2025). Pathophysiological Mechanisms Underlying Early Brain Injury and Delayed Cerebral Ischemia in the Aftermath of Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Analysis. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1587091"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3390\/pathophysiology30030032","article-title":"Pathophysiology, Management, and Therapeutics in Subarachnoid Hemorrhage and Delayed Cerebral Ischemia: An Overview","volume":"30","author":"Sanicola","year":"2023","journal-title":"Pathophysiology"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Catalano, K., Andereggen, L., Schubert, G.A., Marbacher, S., and Gr\u00fcter, B.E. (2025). Spontaneous Regression of Intracranial Aneurysms\u2014Case Report and Systematic Review of the Literature. Brain Sci., 15.","DOI":"10.3390\/brainsci15050488"},{"key":"ref_4","first-page":"308","article-title":"Geometry of Intracranial Aneurysms and of Intrasaccular Devices May Influence Aneurysmal Occlusion Rates after Endovascular Treatment","volume":"31","author":"Mantilla","year":"2025","journal-title":"Interv. Neuroradiol. J. Peritherapeutic Neuroradiol. Surg. Proced. Relat. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hakozaki, K., Kawakita, F., Aoki, K., Suzuki, H., and pSEED Group (2025). Spinal Drainage and Combined Pharmacotherapy as Potential Strategies to Improve Outcomes for Patients with Poor-Grade Subarachnoid Hemorrhage Treated with Clipping or Coiling but Not Receiving Nimodipine. J. Clin. Med., 14.","DOI":"10.3390\/jcm14082715"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s00701-024-05968-5","article-title":"Risk Factors for Poor Outcome after Aneurysmal Subarachnoid Hemorrhage in Patients with Initial Favorable Neurological Status","volume":"166","author":"Lenkeit","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Batarda Sena, P., Gon\u00e7alves, M., Maia, B., Fernandes, M., and Bento, L. (2025). Evidence-Based Approach to Cerebral Vasospasm and Delayed Cerebral Ischemia: Milrinone as a Therapeutic Option\u2014A Narrative Literature Review and Algorithm Treatment Proposition. Neurol. Int., 17.","DOI":"10.20944\/preprints202501.1161.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12028-023-01713-5","article-title":"Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage","volume":"39","author":"Treggiari","year":"2023","journal-title":"Neurocrit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1007\/s00701-022-05347-y","article-title":"Multidisciplinary and Standardized Management of Patients with Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage","volume":"164","author":"Abdulazim","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nimmo, A., and Younsi, A. (2025). The Relationship Between Inflammation and the Development of Cerebral Ischaemia and Hypoxia in Traumatic Brain Injury\u2014A Narrative Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26168066"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1177\/19714009211024633","article-title":"Neurocritical Care Management of Poor-Grade Subarachnoid Hemorrhage: Unjustified Nihilism to Reasonable Optimism","volume":"34","author":"Mayer","year":"2021","journal-title":"Neuroradiol. J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Davidoiu, A.-M., Minc\u0103, D.I., Rusu, M.C., Hostiuc, S., and Toader, C. (2023). The Fetal Type of Posterior Cerebral Artery. Med. Kaunas Lith., 59.","DOI":"10.3390\/medicina59020231"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Han, K., Nahm, M., Ko, S.-W., Yi, H.-J., Chun, H.-J., Lee, Y.-J., Lee, S.H., Ryu, J., Song, S., and Choi, K.-S. (2025). Influence of Fetal-Type Posterior Cerebral Artery on Morphological Characteristics and Rupture Risk of Posterior Communicating Artery Aneurysms: A Radiomics Approach. J. Clin. Med., 14.","DOI":"10.3390\/jcm14113682"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"868","DOI":"10.4103\/ajns.AJNS_130_17","article-title":"Microsurgical Treatment of Paraclinoid Aneurysms by Extradural Anterior Clinoidectomy: The Fujita Experience","volume":"14","author":"Yamada","year":"2019","journal-title":"Asian J. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kuo, L.-T., and Huang, A.P.-H. (2021). The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22095050"},{"key":"ref_16","first-page":"e64128","article-title":"Evaluating the Prevalence and Clinical Significance of Fetal Posterior Cerebral Artery Variants via Magnetic Resonance Imaging: Insights From a Tertiary Healthcare Facility in Tamil Nadu","volume":"16","author":"Gunasekaran","year":"2024","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Liu, R., and Shao, J. (2022). Research Progress on Risk Factors Related to Intracranial Artery, Carotid Artery, and Coronary Artery Stenosis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.970476"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10143-021-01543-z","article-title":"The Evolution of Intracranial Aneurysm Treatment Techniques and Future Directions","volume":"45","author":"Lee","year":"2022","journal-title":"Neurosurg. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6440","DOI":"10.1038\/s41598-018-24732-1","article-title":"Morphological Parameters and Anatomical Locations Associated with Rupture Status of Small Intracranial Aneurysms","volume":"8","author":"Duan","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Oprea, S., Pantu, C., Breazu, A., Munteanu, O., Dumitru, A.V., Radoi, M.P., Costea, D., and Baloiu, A.I. (2026). A Ruptured Tri-Lobulated ICA\u2013PCom Aneurysm Presenting with Preserved Neurological Function: Case Report and Clinical\u2013Anatomical Analysis. Diagnostics, 16.","DOI":"10.3390\/diagnostics16010073"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104376","DOI":"10.1016\/j.bas.2025.104376","article-title":"Nimodipine after Aneurysmal Subarachnoid Hemorrhage: Shortened Treatment in an Unselected Patient Cohort","volume":"5","author":"Hansen","year":"2025","journal-title":"Brain Spine"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gunda, S.T., Yip, J.H.-Y., Ng, V.T.-K., Chen, Z., Han, X., Chen, X., Pang, M.Y.-C., and Ying, M.T.-C. (2024). The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051507"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wang, H., Chen, X., You, C., Wu, K., and Sun, T. (2025). Navigating Challenges in Hydrocephalus Following Intraventricular Hemorrhage: A Comprehensive Review of Current Evidence. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1630286"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/307\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T10:10:01Z","timestamp":1768817401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,18]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020307"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020307","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,18]]}}}