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. 2024 Jan 24:15910199241227467.
doi: 10.1177/15910199241227467. Online ahead of print.

A rare dissecting anterior inferior cerebellar artery aneurysm treated with flow diversion using a silk vista baby device

Omar Kass-Hout  1 , Ziad Darkhabani  2 , Tibor Becske  1
Affiliations

A rare dissecting anterior inferior cerebellar artery aneurysm treated with flow diversion using a silk vista baby device

Omar Kass-Hout et al. Interv Neuroradiol. .

Abstract

Background: Dissecting intracranial pseudoaneurysms represent a challenge for treatment both endovascularly and surgically.

Methods: We review the treatment course of a ruptured anterior inferior cerebellar artery (AICA) dissecting pseudoaneurysm in a 50-year-old patient and review the history of dissecting aneurysms and AICA aneurysms treatment.

Results: An aneurysm cure was achieved using flow diversion in the AICA. The recent introduction of flow diversion devices that can be deployed through 0.017" microcatheters represents a new avenue for treatment of aneurysms.

Conclusion: To the best of our knowledge this is the first published case of flow diversion in the(?) AICA to treat a dissecting aneurysm. The introduction of Silk Vista Baby and similar future devices is likely to widen the scope of aneurysm treatment utilizing flow diversion in distal distribution with small parent arteries.

Keywords: Anterior inferior cerebellar artery; Silk Vista Baby; aneurysm; dissection; flow diversion.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Digital subtraction angiography of the right vertebral artery documenting the irregular right AICA aneurysm (arrow). (Left in anterior posterior view, right is later view).
Figure 2.
Figure 2.
Selective microcatheter injection of the right AICA documenting the dissecting aneurysm involving the proximal lateral pontine segment of the AICA (Arrow left, aneurysm and segment are demarcated). Notice that this is immediately distal to the bifurcation of the AICA into the medial anterior pontine segments.
Figure 3.
Figure 3.
Post primary coiling documenting minor filling of the posterior lobe of the aneurysm. This is seen on lateral views on right (Arrow). (Left: anterior posterior view, right: later view).
Figure 4.
Figure 4.
One week follow-up DSA documenting minor aneurysm growth at the neck (Arrow). (Left: anterior posterior view, right: later view).
Figure 5.
Figure 5.
Six-week follow up DSA with large growth of the aneurysm (Left: anterior posterior view, right: later view).
Figure 6.
Figure 6.
Left: Positioning of Silk Vista Baby before deployment, notice new coil mass in the inferior pole of the aneurysm. Right: Native image documenting deployment of the device in the AICA covering the bifurcation of the AICA.
Figure 7.
Figure 7.
Post deployment of the Silk Vista Baby documenting occlusion of the AICA proximal to device.
Figure 8.
Figure 8.
Native image documenting the kink in the right AICA post deployment of the device.
Figure 9.
Figure 9.
Placement of second device to correct the occlusive kink.
Figure 10.
Figure 10.
Post treatment in AP (Left) and lateral (Right) views. Notice the course of AICA being straight at this point due to stents adjusting the trajectory of the vessel. No residual aneurysm at this time.
Figure 11.
Figure 11.
Three weeks post Silk Vista Baby device deployment documenting regrowth of the aneurysm in 2D views.
Figure 12.
Figure 12.
Three weeks follow up angiogram 3D reconstruction images showing the lateral pontine segment to have become a dissecting aneurysm without a discrete branch.
Figure 13.
Figure 13.
Five weeks post Silk Vista baby device deployment showing the aneurysm residual continuing to grow. Also, the total diameter of the aneurysm has increased from its initial 7.4 mm to 12 mm.
Figure 14.
Figure 14.
The growth of the aneurysm between week 3 (right) and 5 (left) post Silk Vista Baby device deployment.
Figure 15.
Figure 15.
Twelve weeks post deployment of the Silk Vista Baby. While there is no filling of the aneurysm visualized, the coil mass is clearly not adjacent to the stent.
Figure 16.
Figure 16.
Axial MP Rage T1 post gadolinium MRI brain in the posterior fossa. (A) shows patency of the stent (White arrow). (B) Partially shows patency of the stent (White arrow) and sign of aneurysm recurrence (Grey arrow). (C and D) showing aneurysm regrowth and compression of the pons with the mass effect from the aneurysm (Grey arrow).
Figure 17.
Figure 17.
Selective injection of the right AICA showing slow flow into the aneurysm through a possible side branch; the lateral pontine segment. (Left: Anteroposterior, right: lateral).
Figure 18.
Figure 18.
Balloon test occlusion of the right AICA utilizing a 6 × 7 mm Eclipse balloon demonstrating poor leptomeningeal collaterals from SCA and PICA into the distal distribution of the AICA from vertebral injection.
Figure 19.
Figure 19.
Final angiogram documenting no evidence of aneurysm filling. Notice that the coil mass is adjacent to the stent in this stage.
Figure 20.
Figure 20.
Migration of coil mass to abut the stent over the course of treatment signifying resolution of the aneurysm. Left when associated with aneurysm filling. Right when associated with no filling of the aneurysm. (Green: Silk vista baby. Red: Coil mass).
Figure 21.
Figure 21.
18 months from ictus MRI documenting patency of the stent (White) and resolution of the aneurysm (Black).
See this image and copyright information in PMC

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