Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.

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Treatment of acute thrombosis during stent-assisted coil embolization of ruptured proximal posterior inferior cerebellar artery aneurysm

Brain Circulation ◽

10.4103/bc.bc_51_19 ◽

2020 ◽

Vol 6 (2) ◽

pp. 130

Author(s):

Yong Zhang ◽

Guangwen Li ◽

Tonghui Liu ◽

Naidong Wang

Keyword(s):

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Acute Thrombosis ◽

Cerebellar Artery

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Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms

Journal of Neurosurgery ◽

10.3171/2015.12.jns151716 ◽

2017 ◽

Vol 126 (1) ◽

pp. 45-51 ◽

Cited By ~ 2

Author(s):

Jun Wang ◽

Xin-Feng Liu ◽

Bao-Min Li ◽

Sheng Li ◽

Xiang-Yu Cao ◽

...

Keyword(s):

Stent Placement ◽

Late Onset ◽

Posterior Inferior Cerebellar Artery ◽

Small Subset ◽

Acceptable Result ◽

Basilar Artery Thrombosis ◽

Artery Thrombosis ◽

Cerebellar Artery ◽

Placement Technique

OBJECTIVE Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs. METHODS Eight patients with 8 unruptured VFAs who underwent parallel stent placement between April 2011 and August 2012 were included. The diameters of the VFAs ranged from 7.9 to 14.0 mm, and the lengths from 27.5 to 54.4 mm. Of the 8 patients with unruptured VFAs, 3 received double or triple parallel stents and 5 patients received a series-connected stent with another 1 or 2 stents deployed parallel to them. Outcomes for these patients were tabulated, based on the modified Rankin Scale (mRS) score and angiographic results. RESULTS All of the 25 stents were successfully placed without any treatment-related complications. During follow-up, 5 patients had decreased mRS scores, 2 were unchanged, and 1 was increased for subarachnoid hemorrhage. Immediate and follow-up clinical outcome was completely or partially recovered in most patients. Follow-up angiograms revealed 2 aneurysms were reduced in size and 6 were unchanged after stent placement. No in-stent stenosis, occlusion of the posterior inferior cerebellar artery, or perforators jailed by the stent occurred in any of the aneurysms. CONCLUSIONS These results provide encouraging support for the parallel-stent placement technique, which can be envisaged as an alternative strategy against unruptured VFAs. However, testing in more patients is needed.

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Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

Interventional Neuroradiology ◽

10.1177/1591019918809087 ◽

2018 ◽

Vol 25 (2) ◽

pp. 164-171

Author(s):

George H Tse ◽

Andrew Martin ◽

Richard A Dyde ◽

Stuart C Coley

Keyword(s):

Systematic Review ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Endovascular Coiling ◽

Persistent Hypoglossal Artery ◽

Randomised Study ◽

Hypoglossal Artery ◽

Qualitative Systematic Review ◽

Cerebellar Artery ◽

Patient Reported

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

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Challenges in the Management of a Ruptured Bihemispheric Posterior Inferior Cerebellar Artery Aneurysm

World Neurosurgery ◽

10.1016/j.wneu.2018.11.051 ◽

2019 ◽

Vol 122 ◽

pp. 317-321 ◽

Cited By ~ 1

Author(s):

Chin Lik Tan ◽

Gopinathan Anil ◽

Tseng Tsai Yeo ◽

Ning Chou

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Cerebellar Artery

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Rupture of previously documented small asymptomatic saccular intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1992.76.6.1019 ◽

1992 ◽

Vol 76 (6) ◽

pp. 1019-1024 ◽

Cited By ~ 56

Author(s):

Wouter I. Schievink ◽

David G. Piepgras ◽

Fremont P. Wirth

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Intracranial Aneurysms ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Careful Consideration ◽

Middle Cerebral Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Cerebellar Artery ◽

Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

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