The PICA was also dominant, supplying a wide vascular territory in the bilateral cerebellum (the “bihemispheric PICA” variant).

The second patient was a 56-year-old man who presented with a Hunt–Hess grade II, localized SAH due to a ruptured right VADA involving a PICA. The PICA was dominant, supplying a wide vascular territory in the right cerebellum (the “PICA–anterior inferior cerebellar artery” variant). Here, we report two cases of ruptured VADA involving a dominant PICA that were successfully treated with surgical occlusion with occipital artery (OA) to PICA bypass, while avoiding postoperative ischemia.Ĭase description: The first patient was a 47-year-old woman who presented with a Hunt–Hess grade III, diffuse subarachnoid hemorrhage (SAH) due to a ruptured right VADA involving a PICA. One patient died during the follow-up period from an unrelated medical illness (community acquired pneumonia).įlow diverters can be successfully placed within the PICA to treat both ruptured and unruptured aneurysms, and they represent an alternative treatment option to endovascular coiling or microscopic neurosurgery.īackground: In clinical practice, the optimal treatment approach for ruptured vertebral artery dissecting aneurysm (VADA) involving a posterior inferior cerebellar artery (PICA) remains unclear. There was no evidence, either clinical or radiological, of medullary or pontine infarction. Follow-up data were available for two patients and this showed complete occlusion of the aneurysm with the PICA remaining patent. The procedure was a technical success in all cases and there were no intraoperative complications. We present the angiographic and clinical follow-up data. Adjunctive techniques such as coiling were not used. Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. The proposed classification system aids in that selection. We present the first described cases of successful PED treatment of PICA aneurysms with direct placement of the PED in the PICA vessel itself. The PED may be used successfully to treat select aneurysms of the PICA. All PEDs were patent and all patients were independent at the last follow-up. Three patients had the PED placed entirely in the PICA and no patient suffered from a medullary or cerebellar stroke. All aneurysms were successfully treated, with 8/10 completely obliterated and 2 with a partial reduction in size. These were classified based on their morphology and location into two main types and five total subtypes for consideration of treatment with flow diversion. Vertebral aneurysms without disease in the PICA were excluded from the study.ġ0 PICA aneurysms were treated during the study period. PICA aneurysms were defined as aneurysms that involved the PICA. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases of PICA aneurysms treated with the PED. Institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with the PED. We assessed our multi-institutional experience treating these lesions, including the first reported cases of the PED placed within the PICA. Due to the unique anatomy and morphology of these aneurysms, it requires special attention. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed.

The pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results.

Wallenburg pica syndrome step 1