Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion

Cellerini, M.; Mangiafico, Salvatore; Ammannati, Franco; Ambrosanio, G.; Muto, Mario; Galasso, Luigi; Mennonna, P

doi:10.1007/s00234-007-0333-y

Cited by 39 publications

(12 citation statements)

References 14 publications

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“…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. 11 One author reported a high rebleeding risk (24%) in the acute phase of the posterior circulation dissections, with an associated high mortality rate. 18 We had 1 patient (17%) with rebleeding in the acute phase who was treated when the second hemorrhage occurred.…”

Section: Discussionmentioning

confidence: 99%

“…Successful endovascular embolization of dissecting PICA aneurysms has been reported 8,24 and is considered relatively safe and reliable. Cellerini et al 11 reported successful endovascular treatment of ruptured dissecting PICA aneurysms without parent vessel occlusion in 6 patients. In their series, despite complete embolization of the aneurysms after the procedure, they had 3 early recurrences (27%), which represents a relatively high rate of early recurrence given the small series.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors insist that these lesions are highly unstable. 11 Choi et al 25 reported rerupture following the endovascular treatment of a dissecting aneurysm in the distal anterior inferior cerebellar artery with parent artery preservation. They retreated by parent artery occlusion with detachable coils.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The endovascular approach in most cases occluded the parent artery near or at the level of the dissecting aneurysm. However, Cellerini et al 11 and others reported coil treatment of the dissecting aneurysm sacs without parent artery occlusion, claiming it would prevent any chance of PICA territory infarct.…”

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confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…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

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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.

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Aneurysms

Bradač¹

2017

Applied Cerebral Angiography

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Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion

Abstract: Coiling of ruptured, isolated dissecting aneurysms of the PICA without parent vessel occlusion is feasible, relatively safe and effective in preventing early/medium-term rebleeding. A strict angiographic follow-up program is, however, necessary to detect recurrence.

Cited by 39 publications

References 14 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

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

Aneurysms

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