Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion

Wallace, Adam N.; Kamran, Mudassar; Madaelil, Thomas P; Kayan, Yasha; Osbun, Joshua W.; Roy, Anil K.; Almandoz, Josser E Delgado; Moran, Christopher J.; Howard, Brian M.; Yasin, Junaid; Grossberg, Jonathan A

doi:10.1016/j.wneu.2018.03.036

Cited by 45 publications

(20 citation statements)

References 18 publications

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“…Wallace et al have suggested that PICA origin aneurysms have a lower rate of occlusion following PED placement due to persistent flow into the PICA. 13 Thus, distal PICA aneurysms specifically may represent an attractive target for flow diversion. The appeal of PED is especially high for distal PICA aneurysms that would otherwise require surgical trapping and bypass.…”

Section: Discussionmentioning

confidence: 99%

“…Some series studying outcomes of flow diversion in the posterior circulation have included a small number of PICA aneurysms treated with PED, 11 while other reports on PICA aneurysms primarily include PEDs placed in the vertebral artery to treat aneurysms at the PICA origin. 12 , 13 There is therefore a need to assess the safety and efficacy of PED for treatment of distal PICA aneurysms in order to guide therapeutic decision-making. In this work, we report clinical and angiographic outcomes of flow diversion with PED in the distal PICA to share our treatment strategy and outcomes of flow diversion in this region.…”

Section: Introductionmentioning

confidence: 99%

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Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

et al. 2021

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Background and purpose Flow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of distal PICA aneurysms with PED is sometimes performed but has not been well studied. Here, we report our experience with flow diversion of distal PICA aneurysms with PED. Materials and methods Clinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, ischemic or hemorrhagic complication, technical complication, and in-stent stenosis. Results Three female and 2 male patients underwent placement of PED in the PICA for treatment of 5 distal PICA aneurysms. Clinical and angiographic follow-up was obtained for all patients. Complete aneurysm occlusion was observed in 100% (5/5) of treated aneurysms at 6 month and longest angiographic follow-up. While there were no ischemic or device-related complications, delayed hemorrhagic complications occurred in 20% (1/5) of patients. Conclusion Pipeline embolization of distal PICA aneurysms can be performed in select patients. Further study is necessary in larger cohorts to better define clinical scenarios in which flow diversion in the distal PICA should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

et al. 2021

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“…The patient in this case initially underwent a pipeline embolization to manage her PICA aneurysm, a strategy which has shown promising results in the past few years [ 3 - 4 ]. Many times, management of PICA aneurysms using pipeline embolization devices (PED) involves placing the device in the vertebral artery.…”

Section: Discussionmentioning

confidence: 99%

“…To access the aneurysm, the occipital condyle often had to be removed, causing many patients to experience craniocervical instability. In recent years, pipeline embolization has been shown to be a minimally invasive method of occluding the aneurysm [ 3 - 4 ]. The use of the pipeline stent has been shown to have reduced morbidity compared to microsurgical clipping [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent

Suresh¹,

Jenson²,

Britz³

2021

Cureus

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Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with limited consensus on appropriate management. These aneurysms have been noted to have a faster growth rate and are more prone to rupture. Accessing these aneurysms for microsurgical clipping is challenging, and has traditionally required significant removal of the occipital condyle, putting the patient at risk for future complications. Therefore, some have opted to utilize minimally invasive techniques such as a pipeline stent, though these methods can fail to cause complete occlusion of the aneurysm. The current case describes a patient who was found to have a PICA aneurysm that was initially managed with a pipeline stent. However, upon further follow up, the aneurysm showed continued filling, leading to the decision to clip the aneurysm. In this case, we describe the use of a far lateral approach for accessing and clipping a PICA aneurysm with minimal removal of the occipital condyle. The patient successfully tolerated the surgery and was discharged home.

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“…Recently, the safety and effectiveness of flow diverters for PICA aneurysms were reported, although they were for off-label use. 8 A flow diverter enables full coverage of the aneurysm neck without direct intra-aneurysmal manipulation with greater flexibility and adaptable radial force. 9 Currently, there still remain problems of risk of branch occlusion, ischemic complications, and technical problems resulting from small caliber and tortuosity of parent arteries.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

et al. 2020

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Vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms are rare lesions that are difficult to treat with both endovascular and surgical techniques. Tight angulation of the PICA from VA may make access to the PICA difficult from ipsilateral VA if adjunctive techniques are needed. Recently, the safety and efficacy of retrograde access have been reported. We report a case of endovascular treatment for a VA-PICA aneurysm with a stent-assisted technique using retrograde access via contralateral persistent primitive proatlantal artery (PPA). The patient was a 76-year-old woman with an unruptured VA-PICA aneurysm on the dominant VA side. Coil embolization with a stent-assisted technique using retrograde access seemed appropriate. However, the origin of the left VA was not confirmed. Left common carotid artery angiography demonstrated that the PPA (type 1) branching from external carotid artery joined the VA V4 segment. Retrograde access via the PPA for stenting was performed. A microcatheter for stenting was retrogradely advanced to the right PICA at ease. After deploying the stent, coil insertion was completed from the right VA, and the final angiogram showed adequate occlusion of the aneurysm with preservation of the PICA. Thus, PPA may be an approach route in the treatment of VA-PICA aneurysms with unconfirmed contralateral VA orifice and apparent PPA on angiography, when retrograde access is needed.

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Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion

Cited by 45 publications

References 18 publications

Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent

Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

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