Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysm. Report of two exemplary cases and retrospective analysis of 11 cases

Abstract

Background and purpose: Although endovascular therapy for intracranial aneurysms has recently started to replace surgical treatment and literature regarding endovascular therapy's advantages and disadvantages is being published, literature concerning the endovascular treatment of distal posterior inferior cerebellar artery (PICA) aneurysms specifically limited to rupture are lacking. We describe the clinical characteristics of ruptured distal PICA aneurysms, their clinical outcomes, and the strategies in which endovascular treatment are used.

Patients and methods: Eleven consecutive patients with ruptured distal PICA aneurysm with at least 1 year of follow-up were retrospectively reviewed. Clinical profiles and radiologic and interventional methods were analyzed.

Results: The mean age at the time of treatment was 56.3 years (range: 30-86 years). The 11 patients consisted of 8 women (72.7%) and 3 men (27.3%). Six patients had a saccular aneurysm; 5 had a dissecting aneurysm. The aneurysms were located at the lateral medullary segment (n = 5), telovelotonsillar segment (n = 4), and tonsillomedullary segment (n = 2). The mean maximal aneurysm diameter was 6.5 ± 3.1 mm (range: 3.4-12.7 mm). Of the 11 aneurysms, 6 were treated with pure aneurysm coiling, 4 were treated with coil trapping, and 1 was treated with stent-assisted coiling. Complete aneurysm obliteration was achieved in nine patients (pure coiling: five, coil trapping: three, stent-assisted coiling: one), and a residual neck was found in two patients (pure coiling: two). Good outcomes (Glasgow Outcome Scale [GOS] of 4 or 5) were achieved in nine patients (pure coiling: five, coil trapping: four), a GOS of 3 was recorded in one patient (stent-assisted coiling), and one patient (pure coiling) had a GOS of 1.

Conclusion: The present data suggest that endovascular treatment for ruptured distal PICA aneurysms is a safe and effective treatment modality under an elaborate treatment plan.