scholarly journals Antegrade recanalization of parent artery in proximal occlusion of distal posterior inferior cerebellar artery ruptured aneurysm

Medicine ◽  
2021 ◽  
Vol 100 (50) ◽  
pp. e28260
Author(s):  
Hyung-Gyu Jang ◽  
Jung-Soo Park
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Ruptured Aneurysm ◽  
Parent Artery ◽  
Cerebellar Artery ◽  
Proximal Occlusion

Endovascular treatment for ruptured vertebral dissecting aneurysms involving PICA: Reconstruction or deconstruction? Experience from 16 patients

2020 ◽  
pp. 159101992097003
Author(s):  
Xiangjie Kong ◽  
Zeyu Sun ◽  
Chenhan Ling ◽  
Liang Xu ◽  
Cong Qian ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
First Line ◽  
Optimal Method ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms

Objective Ruptured vertebral dissecting aneurysms (VDAs) with posterior inferior cerebellar artery (PICA) involved require an optimal method to isolate the dissection and prevent the symptomatic infraction. This study aims to present our experience with both parent artery occlusion (PAO) and stent-assisted coiling (SAC), and provide a favorable strategy to the management of ruptured VDAs with PICA involved. Methods We retrospectively reviewed patients with subarachnoid hemorrhage in our database from March 2013 to December 2018, suffering from dissecting aneurysms of the intradural vertebral arteries and endovascularly treated. A total of 16 cases with PICA involved were included. Basic information, aneurysm characteristics, procedure related complications and outcomes of patients were analyzed. Results 10 (62.5%) aneurysms were managed with PAO containing 3 proximal occlusion and 8 targeted-trapping preserved the PICA. 5 (31.3%) aneurysms were treated with SAC and one 6.3%) treated with vertebral artery to PICA stenting and trapping. Two (12.5%) patients died in the acute phase. Good clinical outcomes (modified Rankin Scale 0 to 3) were observed in 13(81.5%) cases in 30 days follow-up. PICA territory infraction was happened in one patient without any dysfunction. Favorable occlusion was observed in 9 of 12 (75%) which were free of further treatment. Conclusions For patients with good contralateral circulation, PAO could be a first line management for ruptured VDAs with PICA involved. Targeted-trapping with either reserved PICA or proximal occlusion with moderate coiling in aneurysm are promising modalities to prevent severe PICA infraction.

scholarly journals Successful endovascular treatment of a ruptured bihemispheric posterior inferior cerebellar artery aneurysm: illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Shingo Nishihiro ◽  
Tomotsugu Ichikawa ◽  
Yu Takahashi ◽  
Yuichi Hirata ◽  
Nobuhiko Kawai ◽  
...  
Keyword(s):  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Ruptured Aneurysm ◽  
Cerebellar Hemisphere ◽  
Parent Artery ◽  
Illustrative Case ◽  
Related Complication ◽  
Cerebellar Artery ◽  
Sudden Headache

BACKGROUND Normal posterior inferior cerebellar artery (PICA) anatomy is highly variable, but bihemispheric PICA crossing the midline to supply the vascular territory of bilateral cerebellar hemisphere is rare. Herein, the authors reported a rare case of ruptured aneurysm that was associated with bihemispheric PICA and successfully treated endovascularly. OBSERVATIONS A 46-year-old woman presented with sudden headache and loss of consciousness because of an intraventricular hemorrhage due to a ruptured aneurysm that was associated with the bihemispheric PICA. Angiography revealed that the aneurysm was located at the bifurcation between the bihemispheric PICA and the bilateral distal PICA. The ruptured aneurysm was successfully occluded using coil embolization, which preserved the parent artery with no procedural-related complication. LESSONS To the best of the authors’ knowledge, this was the first report of a ruptured aneurysm associated with bihemispheric PICA being successfully treated endovascularly. Aneurysm formation may be accelerated by hemodynamic stress and vascular fragility. For neurosurgeons and neurointerventionalists, it is important to understand the anatomical variation of PICA, especially bihemispheric PICA, which is a potential risk factor for a fatal stroke.

scholarly journals Paraplegia due to a ruptured aneurysm of the distal posterior inferior cerebellar artery.

1992 ◽  
Vol 55 (9) ◽  
pp. 836-837 ◽  
Author(s):  
S Kashiwagi ◽  
E Tsuchida ◽  
Y Shiroyama ◽  
H Ito ◽  
T Yamashita
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Ruptured Aneurysm ◽  
Cerebellar Artery

scholarly journals Parent Artery Occlusion for Intracranial Aneurysms

2009 ◽  
Vol 15 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Lishan Cui ◽  
Qiang Peng ◽  
Wenbo Ha ◽  
Dexiang Zhou ◽  
Yang Xu
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Artery Occlusion ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Dissecting Aneurysms

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.

scholarly journals Treatment of Dissecting Vertebral Aneurysm

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 155-160 ◽  
Author(s):  
Y. Kai ◽  
J. Hamada ◽  
M. Morioka ◽  
T. Todaka ◽  
T. Mizuno ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
The Other ◽  
Cerebellar Artery ◽  
Retrograde Filling ◽  
Angiographic Evidence ◽  
Vertebral Aneurysm ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site. We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.

Operative nuances of an occipital artery to posterior inferior cerebellar artery bypass

2009 ◽  
Vol 26 (5) ◽  
pp. E19 ◽  
Author(s):  
R. Webster Crowley ◽  
Ricky Medel ◽  
Aaron S. Dumont
Keyword(s):  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Complex Aneurysms ◽  
Cerebellar Artery ◽  
Proximal Occlusion ◽  
Attention To Detail

Occipital artery to posterior inferior cerebellar artery bypasses remain an important tool for cerebrovascular neurosurgeons, particularly in the management of complex aneurysms of the posterior inferior cerebellar artery requiring proximal occlusion or trapping. The procedure requires meticulous technique and attention to detail. The authors outline their technique for accomplishing this bypass emphasizing nuances for complication avoidance.

Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience

2016 ◽  
Vol 9 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Feng Xu ◽  
Yong Hong ◽  
Yongtao Zheng ◽  
Qiang Xu ◽  
Bing Leng
Keyword(s):  
Endovascular Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Selective Embolization ◽  
Single Center Experience ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Pica Aneurysms

AimTo report our experience with endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms.MethodsBetween January 2007 and December 2014, 40 patients with 42 PICA aneurysms were treated with endovascular embolization at our institution. Twenty-eight patients had 29 saccular aneurysms and 12 patients had 13 fusiform/dissecting aneurysms. The endovascular modalities were: (1) selective occlusion of the aneurysm with or without stent assistance (n=19); (2) occlusion of the aneurysm and the parent artery (n=22); and (3) occlusion of the aneurysm including the vertebral artery and PICA origin (n=1). Specifically, selective embolization was performed in 93.3% of aneurysms (14/15) proximal to the telovelotonsillary segment.ResultsImmediate angiographic results included 31 complete occlusions (74%), 3 nearly complete occlusions (7%), and 8 incomplete occlusions (19%). Mean follow-up of 20 months in 31 aneurysms showed 27 stable results, 3 further thromoboses, and 1 recurrence. Final results included 27 complete occlusions (87.1%) and 4 incomplete occlusions (12.9%). There were 5 overall procedural-related complications (12.5%), including 1 infarction (2.5%) and 4 intraprocedural ruptures (10.0%). Procedure-related morbidity and morbidity was 5.0% (2/40) and 2.5% (1/40), respectively. Clinical outcome was excellent (Glasgow Outcome Scale 5 in 31 of 33 patients at long-term follow-up).ConclusionsPICA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiologic outcomes. Further studies are required to compare the safety and efficacy of endovascular treatment with open surgery.

Treatment of vertebral artery aneurysms with transposition of the posterior inferior cerebellar artery to the vertebral artery combined with parent artery occlusion

2006 ◽  
Vol 105 (5) ◽  
pp. 781-784 ◽  
Author(s):  
Kuniaki Ogasawara ◽  
Yoshitaka Kubo ◽  
Nobuhiko Tomitsuka ◽  
Masayuki Sasoh ◽  
Yasunari Otawara ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
The Other ◽  
Parent Artery ◽  
Pica Pica ◽  
Suboccipital Craniectomy ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Good Patency

✓ The authors describe transposition of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) combined with parent artery occlusion for the treatment of VA aneurysms in cases in which a clip could not be applied because of the origin of the ipsilateral PICA. The aneurysm is trapped through a lower lateral suboccipital craniectomy. The PICA is then cut just distal to the aneurysm, and the PICA and VA proximal to the aneurysm are anastomosed in an end-to-end or end-to-side fashion. The surgical procedure was successfully performed in two patients, each of whom had hypoplastic occipital arteries (OAs). The PICA contralateral to the lesion was hypoplastic in one patient and distant to the ipsilateral PICA in the other patient. Mild transient dysphagia developed postoperatively in one patient due to glossopharyngeal and vagus nerve palsy, and the other patient had an uneventful postoperative course. In both patients, postoperative cerebral angiography demonstrated good patency of the transposed PICA. These results show that transposition of the PICA to the VA is a useful procedure for the reconstruction of the PICA when parent artery occlusion is necessary to exclude a VA aneurysm involving the origin of the PICA and when OA–PICA anastomosis or PICA–PICA anastomosis cannot be performed.

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