Elsevier

World Neurosurgery

Volume 114, June 2018, Pages e581-e587
World Neurosurgery

Original Article
Endovascular Treatment of Posterior Inferior Cerebellar Artery Aneurysms with Flow Diversion

https://doi.org/10.1016/j.wneu.2018.03.036Get rights and content

Highlights

  • PED was used to treat 14 PICA aneurysms.

  • Complication rates were 7% (1/14) per patient and 6% (1/16) per procedure.

  • Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases.

  • All PICAs covered with PED remained patent.

Background

Flow diversion is a viable alternative for treatment of wide-neck and fusiform aneurysms originating from the posterior inferior cerebellar artery (PICA), but coverage of the PICA and vertebral perforating arteries may be a concern. The aim of this study was to examine procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device.

Methods

Retrospective review was performed of PICA aneurysms treated with the Pipeline device at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes.

Results

In 16 procedures, 14 PICA aneurysms were treated with the Pipeline device. These included 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0–11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0–8.0 mm) and mean length of 10.3 mm (range, 6.0–15.0 mm). One patient developed a PICA territory infarct with mild leg weakness that resolved in <7 days. Overall complication rate was 7% (1/14) per patient and 6% (1/16) per procedure. Mean duration of clinical follow-up was 13.5 months (range, 3 weeks to 61.7 months), with all patients returning to baseline functional status. Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases with angiographic follow-up (mean, 15 months; range, 4–61 months). All covered PICAs remained patent.

Conclusions

Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.

Introduction

Aneurysms of the posterior inferior cerebellar artery (PICA) are uncommon, representing 0.5%–3% of all intracranial aneurysms.1, 2 Flow diversion is an attractive option for reducing flow to wide-necked and fusiform aneurysms originating from the PICA, but coverage of the PICA and vertebral perforating arteries may be a concern. The purpose of this study was to examine the procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic, Minneapolis, Minnesota, USA).

Section snippets

Materials and Methods

Retrospective review of the neurointerventional databases of 3 high-volume neurovascular centers was approved by respective institutional review boards to identify patients with PICA aneurysms treated with the PED between January 2012 and July 2017. Each participating institution performs >100 endovascular aneurysm treatments per year and has deployed >200 PEDs. Demographic, clinical, and angiographic data were collected from electronic medical records. Patient functional status before and

Patient and Aneurysm Characteristics

During the study period, 14 PICA aneurysms in 14 patients were treated with 16 procedures. The cohort included 2 men and 12 women, with a mean age of 66.2 years (range, 41–76 years). Table 1 summarizes pertinent demographic and aneurysm characteristics. There were 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0–11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0–8.0 mm) and mean length of 10.3 mm (range, 6.0–15.0 mm). The aneurysms involved dominant

Surgical Treatment of PICA Aneurysms

The primary challenge of surgical treatment of PICA aneurysms stems from their deep location and close proximity to the brainstem and lower cranial nerves.1, 3 In a recent case series of surgically treated PICA aneurysms, 48% (25 of 52) of patients developed postoperative lower cranial nerve palsies. Three of these patients (12%; 3 of 25) had long-term disability, whereas the remaining patients recovered within 3–9 months.4 Patients with postoperative lower cranial nerve palsies are at risk of

Conclusions

Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.

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Cited by (15)

  • Outcomes and Complications After the Use of the Pipeline Embolization Device in the Treatment of Intracranial Aneurysms of the Posterior Circulation: A Systematic Review and Meta-Analysis

    2019, World Neurosurgery
    Citation Excerpt :

    Previous case series have reported on the feasibility and efficacy of endovascular treatment with PED for these patients. These facts are supported by the high obliteration and low complication rates achieved after the using this approach in most studies.11-16 Nevertheless, more recent large studies reported that compared with anterior circulation aneurysms, posterior circulation aneurysms treated by PED had higher procedure-related morbidity and mortality.17,18

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Conflict of interest statement: J.E. Delgado is a consultant for Medtronic, MicroVention, Accriva Diagnostics, Penumbra, and Sequent Medical. Y. Kayan is a consultant for Medtronic, MicroVention, and Penumbra. C.J. Moran is a consultant for Medtronic and MicroVention. The remaining authors have no conflicts of interest to disclose.

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