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Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience

BACKGROUND: Posterior inferior cerebellar artery (PICA) like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA)—PICA junction and the proximal segment of the PICA. The surgical clipping of PICA aneurysms can be challenging and carries a...

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Autores principales: Mittal, Somit, Singh, Vivek, Phadke, R. V., Neyaz, Zafar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038216/
https://www.ncbi.nlm.nih.gov/pubmed/30050248
http://dx.doi.org/10.4103/ijri.IJRI_318_17
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author Mittal, Somit
Singh, Vivek
Phadke, R. V.
Neyaz, Zafar
author_facet Mittal, Somit
Singh, Vivek
Phadke, R. V.
Neyaz, Zafar
author_sort Mittal, Somit
collection PubMed
description BACKGROUND: Posterior inferior cerebellar artery (PICA) like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA)—PICA junction and the proximal segment of the PICA. The surgical clipping of PICA aneurysms can be challenging and carries a potentially significant risk of morbidity and mortality. Experience with endovascular therapy has been limited to a few studies; however, the use of endovascular therapy as an alternative treatment to surgery has been increasing. We present our experience of last 5 years in treating the ruptured PICA aneurysms. MATERIALS AND METHODS: A total of 11 patients with PICA aneurysms, out of them 7 were at proximal PICA, 2 at the vertebral-PICA junction, and 1 each at mid and distal PICA, underwent endovascular treatment at our institution between 2011 and 2016. RESULTS: All the patients presented with an acute intracranial hemorrhage, confirmed on CT head. Most of the aneurysms were at proximal PICA (anterior and lateral medullary segments) with the partial incorporation of PICA origin in the sac. Low origin of PICA was seen in 7 (out of 11) cases, out of these cases, 5 had proximal PICA, aneurysm, and one (n = 1) had VA-PICA, junction aneurysm (1/7) and. one distal PICA aneurysm. There were seven proximal PICA aneurysms, and out of them, parent vessel occlusion was done in six and selective coiling in one (n = 1) case. From seven (n = 7) proximal PICA aneurysms, there were five cases of low origin and rests showed normal course and origin. Two (n = 2) junctional aneurysms were treated with simple coiling. Low origin was seen in right VA-PICA junction aneurysm. Endovascular treatment of all the 11 aneurysms was successful. The treatment consisted of selective aneurysm coiling in four (36.3%) patients and aneurysm with parent vessel trapping in seven patients (63.6%). Out of these seven patients, in one (n = 1) patient where aneurysm was distal PICA, glue embolization was done. There was no intra-procedural rupture/contrast extravasation or any thrombo-embolic complications. Follow-up studies ranged from 6 months to 5 years. CONCLUSION: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first-line treatment.
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spelling pubmed-60382162018-07-26 Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience Mittal, Somit Singh, Vivek Phadke, R. V. Neyaz, Zafar Indian J Radiol Imaging Interventional Radiology & Vascular BACKGROUND: Posterior inferior cerebellar artery (PICA) like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA)—PICA junction and the proximal segment of the PICA. The surgical clipping of PICA aneurysms can be challenging and carries a potentially significant risk of morbidity and mortality. Experience with endovascular therapy has been limited to a few studies; however, the use of endovascular therapy as an alternative treatment to surgery has been increasing. We present our experience of last 5 years in treating the ruptured PICA aneurysms. MATERIALS AND METHODS: A total of 11 patients with PICA aneurysms, out of them 7 were at proximal PICA, 2 at the vertebral-PICA junction, and 1 each at mid and distal PICA, underwent endovascular treatment at our institution between 2011 and 2016. RESULTS: All the patients presented with an acute intracranial hemorrhage, confirmed on CT head. Most of the aneurysms were at proximal PICA (anterior and lateral medullary segments) with the partial incorporation of PICA origin in the sac. Low origin of PICA was seen in 7 (out of 11) cases, out of these cases, 5 had proximal PICA, aneurysm, and one (n = 1) had VA-PICA, junction aneurysm (1/7) and. one distal PICA aneurysm. There were seven proximal PICA aneurysms, and out of them, parent vessel occlusion was done in six and selective coiling in one (n = 1) case. From seven (n = 7) proximal PICA aneurysms, there were five cases of low origin and rests showed normal course and origin. Two (n = 2) junctional aneurysms were treated with simple coiling. Low origin was seen in right VA-PICA junction aneurysm. Endovascular treatment of all the 11 aneurysms was successful. The treatment consisted of selective aneurysm coiling in four (36.3%) patients and aneurysm with parent vessel trapping in seven patients (63.6%). Out of these seven patients, in one (n = 1) patient where aneurysm was distal PICA, glue embolization was done. There was no intra-procedural rupture/contrast extravasation or any thrombo-embolic complications. Follow-up studies ranged from 6 months to 5 years. CONCLUSION: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first-line treatment. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6038216/ /pubmed/30050248 http://dx.doi.org/10.4103/ijri.IJRI_318_17 Text en Copyright: © 2018 Indian Journal of Radiology and Imaging http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Interventional Radiology & Vascular
Mittal, Somit
Singh, Vivek
Phadke, R. V.
Neyaz, Zafar
Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title_full Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title_fullStr Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title_full_unstemmed Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title_short Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience
title_sort endovascular treatment of ruptured pica aneurysms and association with its extradural origin: a single-center experience
topic Interventional Radiology & Vascular
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038216/
https://www.ncbi.nlm.nih.gov/pubmed/30050248
http://dx.doi.org/10.4103/ijri.IJRI_318_17
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