Ten of the aneurysms presented with an acute intracranial hemorrhage, and 2 were incidental imaging findings. The mean age of the patients (7 women, 5 men) was 53.5 years (range, 34.0–80.0 years). From the 25 angiographically verified PICA aneurysms, 12 were located distally to the anteromedullary segment of the PICA and composed the case material of this study. The cases were collected from the data base containing all of the patients who had undergone endovascular treatment for their intracranial aneurysm since the start of the endovascular coiling activity in our hospital on December 1993 until March 2008. 6- 9, 11- 21 In the present study, a consecutive series of 12 patients harboring a peripheral PICA aneurysm allocated for endovascular treatment in a single center was retrospectively analyzed. Despite the recently increased number of publications, the pre-existing literature concerning endovascular treatment of peripheral PICA aneurysms is limited and controversial. 10 Endovascular technique enables treating these lesions without craniotomy and the risks related to surgical manipulation. 6- 9ĭue to anatomic location of the PICAs (proximity to brain stem and lower cranial nerves), their surgical treatment is associated with significant risk of neurologic complications. 5 Among peripheral PICA aneurysms, dissecting etiology has been found in 0%-80% of the cases. 2- 4 Approximately 28% of all aneurysms located in the vertebrobasilar arteries, including PICA, have been estimated to be of dissecting origin. 2- 4 Roughly, only a fifth of the PICA aneurysms are thought to arise from more distal segments of the PICA. Posterior inferior cerebellar artery (PICA) aneurysms account for approximately 0.5% to 3.0% of all intracranial aneurysms, 1, 2 and most are located right at the origin or in the first anteromedullary segment of the vessel. Endovascular treatment was effective in preventing rehemorrhage. They were unstable with a high risk of rebleeding and a high mortality if not treated without delay. No rebleedings have occurred during the follow-up.ĬONCLUSION: In this series, most peripheral PICA aneurysms were secondary to arterial dissection. The clinical outcome was good in 7 patients, whereas 3 patients, all poor clinical grade, died (1 for unrelated reasons). One lethal procedural complication occurred, and transient ischemic symptoms appeared in 2 patients. One aneurysm needed retreatment at follow-up. Angiographic outcome was complete aneurysm and/or parent artery occlusion in 9 cases and neck remnant in 1 case. Four aneurysms were treated by endosaccular coiling, 6 (all dissecting) by parent artery occlusion, and in 2 cases endovascular treatment failed. Three dissecting aneurysms reruptured before endovascular treatment, and another 3 demonstrated angiographic progress. RESULTS: The etiology was dissection in 7 (58%) and unknown in 5 cases (42%). Posttreatment and follow-up angiograms were analyzed, and the clinical outcome was recorded. MATERIALS AND METHODS: Twelve consecutive patients with 12 peripheral PICA aneurysms (10 ruptured) included in an internal data base were retrospectively reviewed. 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. BACKGROUND AND PURPOSE: Peripheral aneurysms of the posterior inferior cerebellar artery (PICA) are rare, and pre-existing literature concerning their endovascular treatment is limited.
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