We read with interest the article by Isokangas et al1 about endovascular treatment of peripheral aneurysms of the posterior inferior cerebellar artery (PICA). We agree with the authors that most peripheral aneurysms seem secondary to arterial dissection and can be treated by endovascular techniques.1 We have recent experience in treating 2 consecutive cases of patients with peripheral aneurysms of the posterior circulation with Onyx (Onyx 18 liquid embolic system; ev3, Irvine, Calif) embolization. We illustrate a case of a distal PICA aneurysm and a case of a distal aneurysm of the left superior cerebellar artery (SCA) treated by Onyx embolization with aneurysmal occlusion and no significant morbidity.2 Small areas of cerebellar infarction after embolization developed in both patients, without any significant clinical sequelae.
The article by Isokangas et al1 and our cases illustrate that distal aneurysms of the posterior circulation are now being frequently treated by endovascular techniques, including coiling and parent-vessel sacrifice with Onyx. Onyx embolization of distal aneurysms of the posterior circulation is an alternative and, we believe, a safe technique. It may have the advantage of reduced aneurysmal rupture, but of course, there is always vessel occlusion and resultant infarction, but these infarcts are usually clinically well tolerated if embolization is performed distal to the perforators. It is very important for the interventionalist to understand and recognize the various endovascular treatment options available to treat these unstable lesions, which are associated with a high risk for rebleeding and mortality or morbidity if left untreated.
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