Stent-assisted coil embolization of wide-necked posterior inferior cerebellar artery aneurysms.

INTRODUCTION: Endovascular coil embolization of posterior circulation aneurysms has advantages over a surgical approach. However, the application of coil embolization is sometimes limited in wide-necked posterior inferior cerebellar artery (PICA) aneurysms, which are incorporating the origin of the branch. Presented here is a series of patients who were subjected to stent-supported coil embolization of PICA aneurysms.
METHODS: From a prospective data repository, we retrieved records of seven consecutive patients with PICA aneurysms, all of whom were treated by stent-assisted coil embolization between January 2010 and November 2012. Outcomes were analyzed in terms of aneurysm morphology and clinical status.
RESULTS: In all seven instances, the stents were placed from proximal PICA to vertebral artery (VA). A retrograde approach, via contralateral VA, was performed in five patients, where the origin of PICA from VA assumed an acute angle. In the other two patients, where the angles were obtuse, the stenting was done antegrade, via ipsilateral VA. Out of five patients with retrograde approach, single puncture and a single guiding catheter sufficed in three patients, whereas the remaining two patients required dual puncture and two guiding catheters. Endovascular treatments, as performed, resulted in excellent outcomes for all seven patients, although an asymptomatic thrombus developed in one patient with a ruptured aneurysm.
CONCLUSION: For coil embolization of PICA aneurysm requiring stent protection, either ipsilateral or contralateral VA access routes may be used, depending on the angle of PICA origin and the configuration of the aneurysm.