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. 2021 Dec;27(6):821-827.
doi: 10.1177/15910199211013195. Epub 2021 Apr 23.

Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

David C Lauzier  1 , Brandon K Root  1 , Yasha Kayan  2 , Josser E Delgado Almandoz  2 , Joshua W Osbun  1   3   4 , Arindam R Chatterjee  1   3   4 , Kayla L Whaley  5 , Megan E Tipps  5 , Christopher J Moran  1   4 , Akash P Kansagra  1   3   4
Affiliations

Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

David C Lauzier et al. Interv Neuroradiol. 2021 Dec.

Abstract

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.

Keywords: Aneurysm; endovascular; pipeline embolization device; posterior inferior cerebellar artery.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: YK is a consultant for Microvention, Penumbra, and Medtronic, JEDA is a consultant for Medtronic and Microvention. JWO is a consultant for Medtronic and Microvention. CJM is a consultant for Medtronic and Cerenovus. APK is a consultant for Penumbra, Microvention, and iSchemaView, and is on the iSchemaView medical advisory board. None of these financial disclosures influenced the outcome of this work.

Figures

Figure 1.
Figure 1.
Angiographic images in Patient 3. (a) Axial T1-weighted post-contrast MRI shows a partially thrombosed fusiform aneurysm of the right PICA with mass effect on the brain stem. (b) Pre-treatment angiography showing irregular 6.0 mm lumen of the partially thrombosed aneurysm. (c) Spot image showing complete PED construct containing 4 devices (arrows). (d) 4-month post-treatment angiography demonstrates complete occlusion of the aneurysm.
Figure 2.
Figure 2.
Angiographic images in Patient 5. (a) Pre-treatment 3 D angiography showing a 5.4 mm saccular aneurysm of the distal left PICA. (b) Pre-treatment 2 D angiography image showing aneurysm. (c) Spot image showing single 2.5x10 mm PED deployed across the aneurysm (arrows). (d) 8-month post-treatment angiography demonstrates complete occlusion of the aneurysm.
See this image and copyright information in PMC

References

    1. Lehto H, Harati A, Niemela M, et al. Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients. World Neurosurg 2014; 82: 702–713. - PubMed
    1. Williamson RW, Wilson DA, Abla AA, et al. Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis. JNS 2015; 123: 441–445. - PubMed
    1. Xu F, Hong Y, Zheng Y, et al. Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience. J Neurointerv Surg 2017; 9: 45–51. - PubMed
    1. Deora H, Nayak N, Dixit P, et al. Surgical management and outcomes of aneurysms of posterior inferior cerebellar artery: location-based approaches with review of literature. J Neurosci Rural Pract 2020; 11: 34–43. - PMC - PubMed
    1. Peluso JP, van Rooij WJ, Sluzewski M, et al. Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 2008; 29: 86–90. - PMC - PubMed