Challenging Endovascular Treatment of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm: A Case Report
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Highlight:
- Posterior inferior cerebellar artery (PICA) aneurysms are rare in occurence.
- The endovascular management of PICA aneursysms is challenging due to anatomical difficulties in accessing the site.
- The rebleeding of PICA aneurysms, although rare than other intracranial anurysms, may still happen and must be considered in their management
ABSTRACT
Introduction Aneurysms of the posterior inferior cerebellar artery (PICA) are rare clinical entities with a lower risk of rupture than other intracranial locations. This makes managing PICA aneurysms challenging and important for neurointerventionists to understand. In this case report, we looked at a rare case of PICA aneurysm with post-coiling rebleeding. Case: We reported a 51-year-old female with complaints of dizziness and vomiting. The patient was found to be hypertensive and a neurologic assessment revealed neck stiffness and left hemiparesis. A computed tomography (CT) scan of the head indicated subarachnoid hemorrhage. CT angiography (CTA) showed an aneurysm at the right proximal PICA. Although endovascular coiling was performed, the patient rebleed one month later. Following the insertion of the second coil, successful embolization was achieved, and the patient showed clinical improvement. Conclusion: PICA aneurysms require careful endovascular management, considering the difficulty of access due to their anatomical location. An understanding of its proper management is of paramount importance to reducing mortality.
Kim CH, Yi KM. Posterior inferior cerebellar artery aneurysm, mimicking lateral medullary infarction: A case report. Ann Geriatr Med Res. 2018; 22(2):102–4. doi: 10.4235/agmr.2018.22.2.102
Williamson RW, Wilson DA, Abla AA, McDougall CG, Nakaji P, Albuquerque FC, et al. Clinical characteristics and long-term outcomes in patients with ruptured posterior inferior cerebellar artery aneurysms: A comparative analysis. J Neurosurg. 2015; 123(2):441–5. doi: 10.3171/2014.10.JNS141079
Mittal S, Singh V, Phadke R V., Neyaz Z. Endovascular treatment of ruptured pica aneurysms and association with its extradural origin: A single-center experience. Indian J Radiol Imaging. 2018; 28(2):232–8. doi: 10.4103/ijri.IJRI_318_17
Hung C-W, Kao C-H, Yeh C-H. Posterior inferior cerebellar artery aneurysm mimicking cervical myeloradiculopathy. Formos J Surg. 2012; 45(3):88–92. doi: 10.1016/j.fjs.2012.01.003
Wang G-X, Liu L-L, Wen L, Cao Y-X, Pei Y-C, Zhang D. Morphological characteristics associated with rupture risk of multiple intracranial aneurysms. Asian Pac J Trop Med. 2017; 10(10):1011–4. doi: 10.1016/j.apjtm.2017.09.015
Wang G, Yu J, Hou K, Guo Y, Yu J. Clinical importance of the posterior meningeal artery: A review of the literature. Neuroradiol J. 2019; 32(3):158–65. doi: 10.1177/1971400919840843
Petr O, Sejkorová A, Bradáč O, Brinjikji W, Lanzino G. Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: A systematic review and meta-analysis. Acta Neurochir (Wien). 2016; 158(12):2415–28. doi: 10.1007/s00701-016-2965-3
Fatehi M, Rizzuto MA, Prakash S, Haw C, Gooderham PA, Redekop GJ. Functional outcomes after treatment of posterior inferior cerebellar artery aneurysms. Cureus. 2020; 12(11):e11746. doi: 10.7759/cureus.11746
Zhu J, Yin L, Che Y, Liu Z, Qi X, Zhou K, et al. Treatment of a giant complicated distal posterior inferior cerebellar artery aneurysm: A case report and literature review. Exp Ther Med. 2020; 20(1):395–400. doi: 10.3892/etm.2020.8724
Deora H, Nayak N, Dixit P, Vikas V, Rao KVLN, Pruthi N, et al. Surgical management and outcomes of aneurysms of posterior inferior cerebellar artery: Location-based approaches with review of literature. J Neurosci Rural Pract. 2020; 11(1):34–43. doi: 10.1055/s-0039-3399486
Sejkorová A, Cihlář F, Hejčl A, Lodin J, Vachata P, Sameš M. Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms. Neurosurg Rev. 2016; 39(1):159–68. doi: 10.1007/s10143-015-0659-6
Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RSC. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet. 2015; 385(9969):691–7. doi: 10.1016/S0140-6736(14)60975-2
Munich SA, Cress MC, Rangel-Castilla L, Sonig A, Ogilvy CS, Lanzino G, et al. Neck remnants and the risk of aneurysm rupture after endovascular treatment with coiling or stent-assisted coiling: Much ado about nothing? Neurosurgery. 2019; 84(2):421–7. doi: 10.1093/neuros/nyy056
Srinivasan VM, Dmytriw AA, Regenhardt RW, Vicenty-Padilla J, Alotaibi NM, Levy E, et al. Retreatment of residual and recurrent aneurysms after embolization with the Woven EndoBridge device: Multicenter case series. Neurosurgery. 2022; 90(5):569–80. doi: 10.1227/neu.0000000000001883
Kim ST, Jeong HW, Jeong YG, In HS. Coiling as retreatment in intracranial aneurysm of de novo formation or regrowth: Case report. Neurointervention. 2013; 8(1):46–51. doi: 10.5469/neuroint.2013.8.1.46
Mahajan A, Goel G, Das B, Banga V. Reruptured previously coiled aneurysm - Is it the ideal time to perform check angiography at six months after endovascular coiling? Neurol India. 2020; 68(3):698–700. doi: 10.4103/0028-3886.289007
Tada Y, Wada K, Shimada K, Makino H, Liang EI, Murakami S, et al. Roles of hypertension in the rupture of intracranial aneurysms. Stroke. 2014; 45(2):579–86. doi: 10.1161/STROKEAHA.113.003072
Hasan DM, Hindman BJ, Todd MM. Pressure changes within the sac of human cerebral aneurysms in response to artificially induced transient increases in systemic blood pressure. Hypertension. 2015; 66(2):324–31. doi: 10.1161/HYPERTENSIONAHA.115.05500
Jung K-H. New pathophysiological considerations on cerebral aneurysms. Neurointervention. 2018; 13(2):73–83. doi: 10.5469/neuroint.2018.01011
Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms. Stroke. 2013; 44(7):2046–54. doi: 10.1161/STROKEAHA.113.000733.
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