ABSTRACT
We report a case of an intracranial aneurysm of the left posterior inferior cerebellar artery, which was treated with a flow-diverting stent. One year later at follow-up, the patient presented with new symptoms due to mass effect in the posterior fossa and a 3-fold enlargement of the aneurysm. Digital subtraction angiography showed an increase in size of the aneurysm with jet flow into the sac. Optic coherent tomography was performed during the procedure, demonstrating a failure of endothelization of the stent with a focal 1-mm opening at the neck of the aneurysm, resulting in jet flow. Parent vessel sacrifice was performed by coiling of the left vertebral artery. The patient had a codominant right vertebral artery and tolerated the procedure well. Two years later, follow-up magnetic resonance angiography showed significant decrease of the size of the aneurysm and symptom regression, with a modified Rankin scale of 1 (functionally independent).
Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm , Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Stents , Technology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Aneurysmal subarachnoid hemorrhage secondary to ruptured small dissecting fusiform aneurysms of the posterior inferior cerebellar artery (PICA) is rare and particularly challenging. Different treatment strategies have been reported in these rare cases. We report 2 patients treated with a novel endovascular approach. CASE DESCRIPTION: Two patients presented with subarachnoid hemorrhage secondary to very small (3 mm and 4 mm) ruptured fusiform aneurysms of the proximal section of the PICA trunk. Both patients were treated by coil embolization combined with parent artery preservation by microcatheter auto-assistance. Both coiling procedures were uneventful, and the patients remained asymptomatic. Long-term follow-up angiography in both patients showed complete occlusion of aneurysms with patency of PICA. CONCLUSIONS: There is no single treatment strategy suitable for all PICA aneurysms. Our proposed method may be best applied to small dissecting fusiform aneurysms located on a small (≤1 mm in diameter) PICA distally to its origin.
Subject(s)
Aneurysm, Ruptured/therapy , Aortic Dissection/therapy , Cerebellum/blood supply , Embolization, Therapeutic , Endovascular Procedures , Subarachnoid Hemorrhage/therapy , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Humans , Male , Middle Aged , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/etiology , Therapy, Computer-AssistedABSTRACT
Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. Arnold et al described 11 cases (1.5%) with triple CAD of a reported 740 patients and just a single (0.1%) quadruple case in the same population. Simultaneous dissection of the four principal vessels is extremely rare. According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1-3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD.
