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Case Reports
. 2021;15(5):339-345.
doi: 10.5797/jnet.cr.2020-0091. Epub 2020 Dec 3.

Double LVIS Jr. Stenting of a Ruptured Proximal Anterior Inferior Cerebellar Artery Aneurysm: A Case Report

Kazuyuki Kuwayama  1 , Akihiro Nakata  1 , Yuichi Furuno  1 , Satoshi Hisaoka  1 , Keigo Matsumoto  1
Affiliations
Case Reports

Double LVIS Jr. Stenting of a Ruptured Proximal Anterior Inferior Cerebellar Artery Aneurysm: A Case Report

Kazuyuki Kuwayama et al. J Neuroendovasc Ther. 2021.

Abstract

Objective: We report a case of ruptured aneurysm at the anterior pontine segment of the anterior inferior cerebellar artery (AICA) which re-ruptured after stent placement and was treated by overlapping stenting.

Case presentation: A 53-year-old woman presented with headache. CT demonstrated subarachnoid hemorrhage. DSA revealed no evident source of bleeding. On day 10, she complained of sudden headache and CT demonstrated re-bleeding. On repeated DSA, an aneurysm at the anterior pontine segment of the right AICA was found. An LVIS Jr. stent was deployed at the right AICA including the aneurysm. On postoperative day 23, the aneurysm ruptured again. Another LVIS Jr. stent was deployed at the same area. On day 56, she was discharged home without neurological deficit.

Conclusion: Intracranial aneurysms not indicated for coil embolization or parent artery occlusion are difficult to treat. Overlapping stenting may be a treatment option for such aneurysms.

Keywords: LVIS Jr.; anterior inferior cerebellar artery; stenting; subarachnoid hemorrhage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. (A and B) CT on admission shows subarachnoid hemorrhage in the right premedullary cistern, ambient cistern, and Sylvian fissure. (C) MRA on admission shows no evident source of bleeding.
Fig. 2
Fig. 2. CT (A) and right vertebral angiography (B–D) just after re-bleeding. (A) CT shows new subarachnoid hemorrhage in the right premedullary cistern. (B and C) Anteroposterior and lateral views show the absence of the right PICA. (D) Oblique view shows a saccular aneurysm (arrow) in the anterior pontine segment of the right AICA. AICA: anterior inferior cerebellar artery; PICA: posterior inferior cerebellar artery
Fig. 3
Fig. 3. Oblique view of the right vertebral angiography. (A) Just after stent placement, the aneurysm is bleeding. (B) A few minutes after stent placement, the aneurysm stops bleeding. (C) Twenty days after stent placement, the aneurysm is smaller than before surgery.
Fig. 4
Fig. 4. (A) Thirty-six days after onset, CT shows new subarachnoid hemorrhage in the right premedullary cistern. Oblique view of the right vertebral angiography. (B) Just after overlapping stenting, the aneurysm disappeared. (C) Ten days after overlapping stenting, the aneurysm did not recur. (D) Twenty months after onset, MRA confirmed that the right AICA is patent. AICA: anterior inferior cerebellar artery
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