Onyx embolization in distal dissecting posterior inferior cerebellar artery aneurysms

2015 ◽  
Vol 8 (5) ◽  
pp. 501-506 ◽  
Author(s):  
Ajit S Puri ◽  
Francesco Massari ◽  
Samuel Y Hou ◽  
Juan Diego Lozano ◽  
Mary Howk ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Posterior Inferior Cerebellar Artery ◽  
Clinical Results ◽  
Endovascular Coiling ◽  
Parent Artery ◽  
Small Series ◽  
Cerebellar Artery ◽  
Mild Disability ◽  
Pica Aneurysms

BackgroundDissecting aneurysms located along the distal segments of the posterior inferior cerebellar artery (PICA) are extremely rare, accounting for only 0.5–0.7% of all intracranial aneurysms. Treatment of these aneurysms is challenging, both surgically and endovascularly. We present our preliminary experience and clinical data utilizing Onyx as an embolization agent in the treatment of these lesions with proximal parent artery preservation.Methods7 consecutive ruptured peripheral PICA aneurysms, in 7 patients, were treated with superselective Onyx embolization at our institutions. According to the anatomical classification of Lister et al, these aneurysms were located in the lateral medullary segment (n=1), tonsillomedullary segment (n=1), and the telovelotonsillary segment (n=5) of the PICA. Technical feasibility, procedure related complications, angiographic results, follow-up diagnostic imaging, and clinical outcome were evaluated.ResultsIn all cases, endovascular treatment was successful, with complete occlusion of the aneurysm with proximal parent artery preservation at the final postprocedural angiogram. Procedure related complications were not observed. One patient with a poor clinical condition at admission died during the initial hospital stay due to extensive subarachnoid and intraventricular hemorrhage. No rebleeding or recanalization was noted during follow-up. Two patients had a residual moderate to severe disability at follow-up. Favorable outcomes, with no or mild disability, were observed in four of the surviving patients.ConclusionsAngiographic, diagnostic imaging, and clinical results of our small series indicate that Onyx embolization of dissecting distal PICA aneurysms with parent artery preservation is an effective option with acceptable morbidity and mortality rate, in those cases in which surgical clipping or endovascular coiling of the aneurysmal sac is not suitable.

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.

scholarly journals Endovascular Treatment of Wide-Neck, Ruptured and Unruptured Aneurysms without Supporting Devices

2013 ◽  
Vol 26 (1) ◽  
pp. 97-105
Author(s):  
S. Milosevic Medenica
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Small Series ◽  
Cerebellar Artery ◽  
Wide Neck

Despite of development of various supporting devices in the endovascular treatment (EVT) of wide-neck aneurysms, the procedure remains very challenging. We describe a small series of patients with relatively wide-neck aneurysms treated only by use of 3D coils without supporting devices. In the period July 2011 - August 2012, we treated 23 patients with aneurysm necks > 4 mm or dome/neck ratios < 2. Aneurysms were located in the anterior circulation in 16 patients and in the posterior circulation in seven. The size of aneurysms ranged from three to 21 mm. EVT was achieved by introducing 3D coils of different dimensions in a “Russian doll” fashion. Immediate angiographic results showed complete aneurysm obliteration in 15 patients, small neck remnant in two, and coil protrusion/herniation in four. In one of these cases we had an occlusion of the parent artery and in another case occlusion of the ascending branch (superior cerebellar artery), fortunately both patients remained symptom-free. Clinical results were excellent in 19 patients. One patient developed mild neurologic deficit in the treated territory immediately after the procedure; the patient recovered with mild hemiparesis. One patient developed a delayed stroke in another territory: after treatment the patient left hospital with dysphasia and hemiparesis. The use of 3D coils without neck supporting devices may be a useful alternative in selected cases of wide-neck aneurysms. Larger series with longer follow-up are needed to evaluate the value of this approach.

Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device

2015 ◽  
Vol 8 (10) ◽  
pp. 1030-1033 ◽  
Author(s):  
Edgar A Samaniego ◽  
German Abdo ◽  
Ricardo A Hanel ◽  
Andrey Lima ◽  
Santiago Ortega-Gutierrez ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Phase ◽  
Posterior Inferior Cerebellar Artery ◽  
Short Term ◽  
Small Series ◽  
Low Profile ◽  
Procedural Complications ◽  
Reconstructive Technique ◽  
Pica Aneurysms

ObjectiveTo describe the treatment of posterior inferior cerebellar artery (PICA) aneurysms with the Low-profile Visualized Intraluminal Support Device (LVIS Jr) stent.Materials and methodsThe databases of three institutions were retrospectively reviewed. Patients who underwent endovascular treatment of PICA aneurysms using a reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complications, and clinical and angiographic follow-up information was recorded and analyzed.ResultsSeven patients who underwent endovascular treatment of PICA aneurysms with an LVIS Jr stent were identified. Four aneurysms were treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. One patient was treated in the acute phase of SAH and required a gycoprotein IIb/IIIa inhibitor after the stent was implanted. This patient needed to be re-treated to complete embolization. All patients had good clinical outcomes (Glasgow Outcome Scale 5). No in-stent stenosis or occlusion was seen on short-term angiographic follow-up and the aneurysms were occluded.ConclusionsThis small series suggests that the use of a reconstructive technique with the LVIS Jr stent for the treatment of PICA aneurysms is feasible, safe and effective in the short term.

Endovascular Surgery for Proximal Posterior Inferior Cerebellar Artery Aneurysms: An Analysis of Glasgow Outcome Score by Hunt-Hess Grades

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 619-625 ◽  
Author(s):  
Robert A. Mericle ◽  
Adam S. Reig ◽  
Matthew V. Burry ◽  
Eric Eskioglu ◽  
Christopher S. Firment ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Surgery ◽  
Glasgow Outcome Score ◽  
Clinical Grade ◽  
Outcome Score ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Angiographic Result

Abstract OBJECTIVE: Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades. METHODS: We reviewed 31 consecutive patients with proximal PICA aneurysms who were treated with endovascular surgery. The following data were analyzed: age, sex, size of aneurysm, Hunt-Hess grade at presentation, Fisher grade at presentation, angiographic result after embolization, complications, number of days hospitalized, duration of follow-up, angiographic follow-up results, and Glasgow Outcome Score at follow-up. RESULTS: Excellent angiographic occlusion was achieved in 30 of 31 (97%) patients. Clinical follow-up with Glasgow Outcome Score was performed on every patient an average of 10 months later. Twenty-one of 31 (68%) patients had good outcomes (Glasgow Outcome Score I or II) at follow-up. Of the patients who presented with a favorable clinical grade (Hunt-Hess 0–III), 13 of 15 (87%) had good outcomes at follow-up. Of the patients who presented with a poor clinical grade (Hunt-Hess Grade IV or higher), 8 of 16 (50%) had good outcomes at follow-up. CONCLUSION: This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.

scholarly journals The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: Report of three cases

2018 ◽  
Vol 24 (5) ◽  
pp. 489-498 ◽  
Author(s):  
Pervinder Bhogal ◽  
Jorge Chudyk ◽  
Carlos Bleise ◽  
Ivan Lylyk ◽  
Hans Henkes ◽  
...  
Keyword(s):  
Treatment Option ◽  
Intraoperative Complications ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Coiling ◽  
Medical Illness ◽  
Unruptured Aneurysms ◽  
Alternative Treatment Option ◽  
Cerebellar Artery ◽  
Flow Diverters

Objective The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. Methods Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. Adjunctive techniques such as coiling were not used. We present the angiographic and clinical follow-up data. Results The procedure was a technical success in all cases and there were no intraoperative complications. Follow-up data were available for two patients and this showed complete occlusion of the aneurysm with the PICA remaining patent. There was no evidence, either clinical or radiological, of medullary or pontine infarction. One patient died during the follow-up period from an unrelated medical illness (community acquired pneumonia). Conclusion Flow diverters can be successfully placed within the PICA to treat both ruptured and unruptured aneurysms, and they represent an alternative treatment option to endovascular coiling or microscopic neurosurgery.

Endovascular sacrifice of the proximal posterior inferior cerebellar artery for treatment of ruptured intracranial aneurysms

2020 ◽  
Vol 12 (8) ◽  
pp. 777-782
Author(s):  
James G Malcolm ◽  
Jonathan A Grossberg ◽  
Nealen G Laxpati ◽  
Ali Alawieh ◽  
Frank C Tong ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
High Morbidity ◽  
Brainstem Compression ◽  
Cerebellar Artery ◽  
Diseased Segment ◽  
Suboccipital Decompression ◽  
Pica Aneurysms ◽  
Ruptured Intracranial Aneurysms ◽  
Dissecting Aneurysms

BackgroundRuptured aneurysms of the intracranial vertebral artery (VA) or posterior inferior cerebellar artery (PICA) are challenging to treat as they are often dissecting aneurysms necessitating direct sacrifice of the diseased segment, which is thought to carry high morbidity due to brainstem and cerebellar stroke. However, relatively few studies evaluating outcomes following VA or proximal PICA sacrifice exist. We sought to determine the efficacy and outcomes of endovascular VA/PICA sacrifice.MethodsA retrospective series of ruptured VA/PICA aneurysms treated by endovascular sacrifice of the VA (including the PICA origin) or proximal PICA is reviewed. Collected data included demographic, radiologic, clinical, and disability information.ResultsTwenty-one patients were identified. Median age was 57 years (IQR 11); 15 were female. The Hunt and Hess grade was mostly 3 and 4 (18/21). Seven cases (33%) involved VA-V4 at the PICA take-off, and 14 cases (67%) involved the PICA exclusively. For VA pathology, V4 was sacrificed in all cases, while for PICA pathology, sacrificed segments included anterior medullary (4/14), lateral medullary (7/14), and tonsillomedullary (3/14) segments. Four patients went to hospice (19%). Twelve patients (57%) had evidence of stroke on follow-up imaging: cerebellar (8), medullary (1), and both (3). One patient required suboccipital decompression for brainstem compression. No aneurysm re-rupture occurred. Median discharge modified Rankin Scale score was 2.0 (IQR 2), which decreased to 1.0 (IQR 1) at median follow-up of 6.5 months (IQR 23).ConclusionsEndovascular sacrifice of V4 or PICA aneurysms may carry less morbidity than previously thought, and is a viable alternative for poor surgical candidates or those with good collateral perfusion.

scholarly journals Re-Growth of a Posterior Inferior Cerebellar Artery Aneurysm after Resection of the Associated Posterior Fossa Arteriovenous Malformation

2014 ◽  
Vol 20 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Hosam Al-Jehani ◽  
Donatella Tampieri ◽  
Maria Cortes ◽  
Denis Melançon
Keyword(s):  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Glue Embolization

Arteriovenous malformation (AVM)-related aneurysms have been described in the literature. Their behavior varies based on their location in relation to and the activity of the shunting through the index AVM. The intuitive expectation supported by numerous reports is that these aneurysms should regress if the AVM is excluded from the circulation. We describe a case of 46-year-old man who presented with a posterior fossa AVM with an aneurysm on the posterior inferior cerebellar artery feeding the AVM. The nidus of the AVM was successfully excluded by glue embolization, with initial regression of the PICA aneurysm on serial imaging. Five years after the endovascular treatment, the aneurysm showed significant re-growth necessitating endovascular coiling. This case presents the re-growth of an AVM-related aneurysm and emphasizes the importance of long-term follow-up of such aneurysms even if the AVM is completely excluded.

scholarly journals Endovascular Treatment of Ruptured Dissecting Posterior Inferior Cerebellar Artery Aneurysms

2012 ◽  
Vol 18 (4) ◽  
pp. 442-448 ◽  
Author(s):  
I. Ioannidis ◽  
N. Nasis ◽  
A. Andreou
Keyword(s):  
Endovascular Treatment ◽  
Medical Center ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Clinical Records ◽  
Dissecting Aneurysms

Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin from vertebral artery (VA) are very rare. Although rare, they associated with a high risk of rebleeding and they present a therapeutic challenge. This study reviewed the clinical presentations, angiographic characteristics of dissecting aneurysms of the PICA and to assess the clinical and angiographic outcomes of patients who underwent endovascular treatment. Ten patients with ten dissecting aneurysms who underwent endovascular treatment were identified in the clinical records of a single medical center from January 2000 to December 2010. The mean follow-up duration was 2.8 years. All patients presented with subarachnoid hemorrhage (SAH). They all underwent endovascular treatment, which included occlusion of the dissected segment and the parent artery after detailed angiographic evaluation of the vascular anatomy, and test occlusion of the PICA. In all patients the endovascular treatment was successfully completed without procedure related complications. Long-term follow-up studies in seven out of ten patients showed complete occlusion of the aneurysm with no new neurologic deficits. The clinical outcome was good in eight cases, whereas two patients with poor clinical condition at admission died during their initial hospital stay. Endovascular occlusion of the parent vessel and the dissected segment is relatively safe treatment option for dissecting aneurysms of the PICA distal to its origin.

scholarly journals Ten years of experience in endovascular treatment of ruptured aneurysms of the posterior inferior cerebellar artery

2016 ◽  
Vol 22 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Robert Juszkat ◽  
Paweł Kram ◽  
Katarzyna Stanisławska ◽  
Roman Jankowski ◽  
Bogumiła Stachowska-Tomczak ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Years Of Experience ◽  
Endovascular Stents ◽  
Ruptured Aneurysms ◽  
Ruptured Intracranial Aneurysm ◽  
Cerebellar Artery ◽  
Pica Aneurysms

Background The aim of this study is to present our 10 years of experience in endovascular treatment of ruptured posterior inferior cerebellar artery (PICA) saccular aneurysms and to compare clinical presentation and outcome after endovascular treatment between patients with PICA aneurysms and patients with aneurysms in different locations. Methods and findings Out of 932 patients with a ruptured intracranial aneurysm treated endovascularly in our institution, 38 aneurysms were located at the posterior inferior cerebellar artery. Clinical presentation, mean aneurysm diameter and outcome of the therapy in this group were compared with the same for ruptured aneurysms in other locations. Patients discharged with favourable outcomes were checked angiographically in the follow-up period. Thirty-four patients with ruptured PICA aneurysms were treated by selective endovascular coiling. Two patients with wide-necked aneurysms had endovascular stents implanted. In two cases, the parent vessel was occluded due to failure to catheterise the target aneurysm. The evaluated variables did not differ significantly between two groups, but significantly more ruptured aneurysms in the PICA group were under 6 mm in diameter. 29.4% of controlled aneurysms needed additional reembolisation in the follow-up period. Conclusions Clinical presentation, extension of subarachnoid haemorrhage and outcome after endovascular treatment did not differ significantly between patients with ruptured aneurysms located on the PICA and patients with aneurysms located elsewhere intracranially. Endovascular treatment is an effective method of therapy in patients with ruptured PICA aneurysms. In our experience, even when sacrificing of the PICA is required, the results of treatment are favourable.

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