Abstract
Background: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging. The experience of pipeline embolization device (PED) therapy for these lesions is still limited.Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA.Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed.Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Images were available in 30 patients (93.8%) during a period of 3–26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Parent artery occlusion (PAO) was occurred in 3 patients (10%). Twenty-eight of 30 PICA remained patent. The two occlusions of PICA were secondary to PAO. At a mean of 20.7 months (range 7–50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit.Conclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA.
Highlights
Vertebral artery aneurysm account for 11% of posterior circulation aneurysms and 3–5% of subarachnoid hemorrhage (SAH) [1,2,3]
Cases were excluded if the aneurysm did not involve posterior inferior cerebellar artery (PICA), the patients presented with subarachnoid hemorrhage, or the aneurysms were not treated with pipeline embolization device (PED)
A total 32 patients with vertebral artery aneurysm involving PICA were included in the present study
Summary
Vertebral artery aneurysm account for 11% of posterior circulation aneurysms and 3–5% of subarachnoid hemorrhage (SAH) [1,2,3]. It is necessary to take more aggressive treatment for the unruptured vertebral artery aneurysm considering the risk of progression and rupture, especially vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA). PED has emerged as a popular treatment option for intracranial aneurysms and achieved promising results [9] This device can preserve parent vessels as well as major side branches while excluding aneurysm from circulation by disrupting flow within the aneurysm and remodeling vessel [10]. These characteristics may be suitable for the treatment for vertebral artery aneurysm involving PICA. The experience of pipeline embolization device (PED) therapy for these lesions is still limited
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