Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms

Chalouhi, Nohra; Jabbour, Pascal; Starke, Robert M.; Tjoumakaris, Stavropoula; Gonzalez, L. Fernando; Witte, Samantha; Rosenwasser, Robert H.; Dumont, Aaron S.

doi:10.3171/2012.12.jns121240

Cited by 91 publications

(91 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PICA occlusion was accompanied by infarcts in 6 (8%) patients, and 4 (5%) patients in the series died in hospital. 2 These results counter the prevailing opinion that PICA is expendable with minimal morbidity. 2,15 Deconstructive approaches that sacrifice the PICA can cause medullary and cerebellar infarcts, cerebellar edema, acute hydrocephalus, and brainstem compression.…”

Section: Bypass Indicationscontrasting

confidence: 55%

“…2 These results counter the prevailing opinion that PICA is expendable with minimal morbidity. 2,15 Deconstructive approaches that sacrifice the PICA can cause medullary and cerebellar infarcts, cerebellar edema, acute hydrocephalus, and brainstem compression. While some of these complications may be tolerable in some cases, they frequently cause deterioration and can require urgent decompressive craniectomy, as in our 2 cases of bypass occlusion.…”

Section: Bypass Indicationscontrasting

confidence: 55%

See 1 more Smart Citation

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

Abla¹,

McDougall²,

Lawton³

2016

JNS

View full text Add to dashboard Cite

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...

show abstract

Section: Bypass Indicationscontrasting

confidence: 55%

Section: Bypass Indicationscontrasting

confidence: 55%

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

Abla¹,

McDougall²,

Lawton³

2016

JNS

View full text Add to dashboard Cite

show abstract

“…7,16 Both microsurgical and endovascular treatment options exist, with acceptable rates of aneurysm occlusion; however, longterm outcome data are lacking for SAH patients with ruptured PICA aneurysms. [2][3][4][5][6]13,16 In this study, we aim to better define the clinical nuances, complications, and longterm outcomes of ruptured PICA aneurysms in patients who were treated as part of the Bar row Ruptured Aneurysm Trial (BRAT) and compare the clinical characteristics of those with ruptured PICA an eurysms versus those with all other types of ruptured in tracranial aneurysms. 12 We hypothesize that patients with ruptured PICA aneurysms fare worse than those with rup tured aneurysms in other locations and that the high rate of lower cranial nerve dysfunction may help to explain this worse outcome.…”

mentioning

confidence: 99%

Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis

Williamson¹,

Wilson²,

Abla³

et al. 2015

JNS

View full text Add to dashboard Cite

OBJect Subarachnoid hemorrhage (SAH) from ruptured posterior inferior cerebellar artery (PICA) aneurysms is uncommon, and long-term outcome data for patients who have suffered such hemorrhages is lacking. This study investigated in-hospital and long-term clinical data from a prospective cohort of patients with SAH from ruptured PICA aneurysms enrolled in a randomized trial; their outcomes were compared with those of SAH patients who were treated for other types of ruptured intracranial aneurysms. The authors hypothesize that PICA patients fare worse than those with aneurysms in other locations and this difference is related to the high rate of lower cranial nerve dysfunction in PICA patients. methOdS The authors analyzed data for 472 patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) and retrospectively reviewed vasospasm data not collected prospectively. In the initial cohort, 57 patients were considered angiographically negative for aneurysmal SAH source and did not receive treatment for aneurysms, leaving 415 patients with aneurysmal SAH. reSultS Of 415 patients with aneurysmal SAH, 22 (5.3%) harbored a ruptured PICA aneurysm. Eight of them had dissecting/fusiform-type aneurysms while 14 had saccular-type aneurysms. Nineteen PICA patients were treated with clipping (1 crossover from coiling), 2 were treated with coiling, and 1 died before treatment. When comparing PICA patients to all other aneurysm patients in the study cohort, there were no statistically significant differences in age (mean 57.6 ± 11.8 vs 53.9 ± 11.8 years, p = 0. , p = 0.53), aneurysm size (mean 6.2 ± 3.0 vs 6.7 ± 4.0 mm, p = 0.55), radiographic vasospasm (53% vs 50%, p = 0.88), or clinical vasospasm (12% vs 23%, p = 0.38). PICA patients were more likely to have a fusiform aneurysm (36% vs 12%, p = 0.004) and had a higher incidence of lower cranial nerve dysfunction and higher rate of tracheostomy/percutaneous endoscopic gastrostomy placement compared with non-PICA patients (50% vs 16%, p < 0.001). PICA patients had a significantly higher incidence of poor outcome at discharge (91% vs 67%, p = 0.017), 1-year follow-up (63% vs 29%, p = 0.002), and 3-year follow-up (63% vs 32%, p = 0.006). cONcluSiONS Patients with ruptured PICA aneurysms had a similar rate of radiographic vasospasm, equivalent admission Fisher grade and Hunt and Hess scores, but poorer clinical outcomes at discharge and at 1- and 3-year followup when compared with the rest of the BRAT SAH patients with ruptured aneurysms. The PICA's location at the medulla and the resultant high rate of lower cranial nerve dysfunction may play a role in the poor outcome for these patients. Furthermore, PICA aneurysms were more likely to be fusiform than saccular, compared with non-PICA aneurysms; the complex nature of these aneurysms may also contribute to their poorer outcome.

show abstract

“…As with other aneurysms located in the posterior circulation, surgical clipping of aneurysms originating in the PICA presents technical challenges due to the deep location, adjacent lower cranial nerves and brainstem 14,15 . Because of these characteristics, endovascular management of aneurysms originating in the PICA has become increasingly utilized in recent years 5,16 , and proved a safe and effective therapy in a recently published large series 11 . Among endovascular treatments, however, PI-CA origin aneurysms have some complex anatomical findings including being wide-necked, the acute-angled PICA branching from the VA, and incorporated the branch into the sac [2][3][4][5] .…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, the guidewire and the microcatheter can cross the vertebrobasilar (VB) PICA aneurysms 11 . The dome-shaped aneurysm required neck remodeling using a stent-assisted catheter jailing method.…”

Section: Introductionmentioning

confidence: 99%

Using the Snare System to Cross the Acute-Angled Vertebrobasilar Junction in Treating Posterior Inferior Cerebellar Artery Aneurysm with the Stent-Assisted Method via a Retrograde Approach

et al. 2014

View full text Add to dashboard Cite

Retrograde stenting via the contralateral vertebral artery (VA) is a safe and effective treatment for posterior inferior cerebellar artery (PICA) aneurysm. Many methods, including tip shaping and the looping technique, have been attempted as ways to cross the vertebrobasilar (VB) junction. Here, we introduce an alternative method using a Snare system to overcome the acute-angled VB junction after repeated failures using other techniques. The Snare system was navigated to the proximal basilar artery via the ipsilateral VA. A guide-wire was introduced in the contralateral VA and gently advanced to the basilar artery in order to pass through the loop of the Snare system. Following this, the Snare system caught the guide-wire and it was very carefully pulled down to the ipsilateral VA crossing the VB junction. We suggest this technique as a method to cross the acute-angled VB junction after failure of all other attempts to overcome this challenge.

show abstract

Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms

Cited by 91 publications

References 33 publications

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

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

Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: a comparative analysis

Using the Snare System to Cross the Acute-Angled Vertebrobasilar Junction in Treating Posterior Inferior Cerebellar Artery Aneurysm with the Stent-Assisted Method via a Retrograde Approach

Contact Info

Product

Resources

About