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AJNR - American Journal of Neuroradiology

Published ahead of print on July 17, 2008
doi: 10.3174/ajnr.A1218

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American Journal of Neuroradiology 29:1783-1788, October 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Treatment of Peripheral Aneurysms of the Posterior Inferior Cerebellar Artery

J.-M. Isokangas^a, T. Siniluoto^a, T. Tikkakoski^c and T. Kumpulainen^b

^a Department of Radiology, Oulu University Hospital, Oulu, Finland
^b Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
^c Department of Radiology, Kokkola Central Hospital, Kokkola, Finland

Please address correspondence to Juha-Matti Isokangas, Department of Radiology, Oulu University Hospital, PO Box 50, FIN-90029 OYS, Oulu, Finland; E-mail: matti.isokangas{at}ppshp.fi

BACKGROUND AND PURPOSE: Peripheral aneurysms of the posterior inferior cerebellar artery (PICA) are rare, and pre-existing literature concerning their endovascular treatment is limited. The purpose of this study was to assess the etiology and clinical characteristics of peripheral PICA aneurysms and to evaluate the angiographic and clinical results of the patients who underwent endovascular treatment for a peripheral PICA aneurysm in a single center.

MATERIALS AND METHODS: Twelve consecutive patients with 12 peripheral PICA aneurysms (10 ruptured) included in an internal data base were retrospectively reviewed. Posttreatment and follow-up angiograms were analyzed, and the clinical outcome was recorded.

RESULTS: The etiology was dissection in 7 (58%) and unknown in 5 cases (42%). Three dissecting aneurysms reruptured before endovascular treatment, and another 3 demonstrated angiographic progress. Four aneurysms were treated by endosaccular coiling, 6 (all dissecting) by parent artery occlusion, and in 2 cases endovascular treatment failed. Angiographic outcome was complete aneurysm and/or parent artery occlusion in 9 cases and neck remnant in 1 case. One aneurysm needed retreatment at follow-up. One lethal procedural complication occurred, and transient ischemic symptoms appeared in 2 patients. The clinical outcome was good in 7 patients, whereas 3 patients, all poor clinical grade, died (1 for unrelated reasons). No rebleedings have occurred during the follow-up.

CONCLUSION: In this series, most peripheral PICA aneurysms were secondary to arterial dissection. They were unstable with a high risk of rebleeding and a high mortality if not treated without delay. Endovascular treatment was effective in preventing rehemorrhage.