Endovascular treatment of PICA aneurysms

Mukonoweshuro, William; Laitt, Roger; Hughes, David G.

doi:10.1007/s00234-002-0913-9

Cited by 56 publications

(47 citation statements)

References 17 publications

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“…Among distal dissecting PICA aneurysms in the literature, the dissecting etiology has been found in 0%-80% of the cases. [15][16][17] In our cases, the etiology of the dissection was presumed to be spontaneous in 5 cases and traumatic in 1 case. The natural history of distal segment dissecting PICA aneurysms is likely different from the more common saccular aneurysms, which frequently arise at the vertebral artery-PICA junction.…”

Section: Discussionmentioning

confidence: 69%

Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management

Lim¹,

Choi²,

Hum³

et al. 2010

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 69%

Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management

Lim¹,

Choi²,

Hum³

et al. 2010

AJNR Am J Neuroradiol

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“…While our results do not specifically address these issues, the endovascular literature provides some insights (Table 4). 3,10,[16][17][18]21,23 The use of stents, stent-assisted coiling, or balloon-assisted coiling improves the rates of PICA preservation, but even in the largest and most recent experience selective aneurysm coiling was possible in 60 of 76 (79%) patients and the PICA was sacrificed deliberately in 11 (14%) patients. PICA occlusion was accompanied by infarcts in 6 (8%) patients, and 4 (5%) patients in the series died in hospital.…”

Section: Bypass Indicationsmentioning

confidence: 99%

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Abla¹,

McDougall²,

Lawton³

2016

JNS

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I ntracranIal-to-IntracranIal (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize efferent branches with in situ donor arteries, and reconstruct bifurcated anatomy with interposition grafts that are entirely intracranial. 25 These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites in the neck toward a more local and reconstructive approach, or, in other words, a more minimally invasive approach to byabbreviatioNs DSA = digital subtraction angiography; EC-IC = extracranial-to-intracranial; IC-IC = intracranial-to-intracranial; mRS = modified Rankin Scale; PICA = posterior inferior cerebellar artery; RAG = radial artery interposition graft; VA = vertebral artery. obJective Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. methods Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. results During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V 3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. coNclusioNs PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one-quarter of all PICA aneurysms treated microsurgically at our center requiring bypass without a single EC-IC bypass. The selection of PICA bypass is almost algorithmic: trapped aneurysms at the PICA origin or p1 segment are revasculari...

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“…In the study with 23 patients treated with endovascular embolization of ruptured PICA aneurysm, one author reported that procedure-related morbidity was 13% with no procedurerelated death and good outcome in 86.4% 14) . Another author reported that endovascular coiling of posterior circulation aneurysm including PICA aneurysm in 8 patients had good outcome in 77.2% 15) .…”

Section: Clinical Outcomes Of Endovascular Treatmentmentioning

confidence: 99%

“…Because of difficulty in general anesthesia due to poor general condition, recent advancement in endovascular surgery, and difficulties related with surgery, endovascular treatment is being used as a primary or alternative method for treating these aneurysms 3,6) . For ruptured or unruptured PICA aneurysms, in our knowledge, many authors 2,4,7,8,14,15) reported the clinical outcomes of surgery or endovascular treatment, but there was only one patients had the left-sided PICA aneurysms. Twelve patients had good initial H-H grade and 8 patients had poor grade.…”

Section: Introductionmentioning

confidence: 99%

Predicting Factors Affecting Clinical Outcomes for Saccular Aneurysms of Posterior Inferior Cerebellar Artery with Subarachnoid Hemorrhage

Hong

Kim

Che

et al. 2011

J Korean Neurosurg Soc

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study that analyzed the predicting factors of clinical outcome 13) . We experienced 20 patients for PICA aneurysms with subarachnoid hemorrhage (SAH). And so, we investigated the clinical outcomes after surgery and endovascular treatment and tried to find the predicting factors affecting the outcomes for ruptured PICA aneurysms. MATERIALS AND METHODS Patient populationsBetween April 1996 and December 2010, 1960 intracranial aneurysms were treated at our institution. Among them, we retrospectively reviewed 20 patients of PICA aneurysms with SAH, of which there were 18 females and 2 males with a mean age of 55.9 (range 42-86 years). In our study, all aneurysms were included except fusiform and dissecting aneurysms. Among them, eleven cases were treated with surgical clipping and 9 cases were treated with endovascular treatment. Patients' data include age, sex, side and location of aneurysm, initial HuntHess (H-H) grade, procedure-related complications, follow-up duration, and Glasgow Outcome Scale (GOS) at last follow-up visit. According to GOS, we categorized the two groups into good (GOS 4 and 5) and poor (GOS 1-3) for the statistical anal- INTRODUCTIONIn view of location, posterior inferior cerebellar artery (PICA) aneurysms are reported to most frequently occur in the region where PICA originates in the vertebral artery (VA) 8,12) . When surgical clipping is performed, there are some risks of neurological complications because of the intimate anatomical relationships of the proximal PICA to the brain stem and lower cranial nerves 2,4,11) . Because of difficulty in general anesthesia due to poor general condition, recent advancement in endovascular surgery, and difficulties related with surgery, endovascular treatment is being used as a primary or alternative method for treating these aneurysms 3,6) . For ruptured or unruptured PICA aneurysms, in our knowledge, many authors 2,4,7,8,14,15) reported the clinical outcomes of surgery or endovascular treatment, but there was only one Results : Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. Conclusion : In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.

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Endovascular treatment of PICA aneurysms

Cited by 56 publications

References 17 publications

Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management

Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Predicting Factors Affecting Clinical Outcomes for Saccular Aneurysms of Posterior Inferior Cerebellar Artery with Subarachnoid Hemorrhage

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