Objective Endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms poses significant technical challenges. We report our early experience in the treatment of PICA aneurysms using a low-profile, self-expanding nitinol braided stent (LVIS Jr, Microvention/Terumo).
Methods The neurointerventional database of our institutions was retrospectively reviewed from October of 2014 to March of 2015. Patients who underwent endovascular treatment of PICA aneurysms using reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complication, clinical and angiographic follow ups were included in the analysis.
Results Among the patients with a PICA aneurysms treated in our neurointerventional database, 4 patients met the inclusion criteria in our study. Patients’ ages ranged from 21 to 63 years old. The mean angiographic diameter of the aneurysms was 6.7 mm (range 3–10 mm) and the mean angiographic diameter of the PICA was 2.05 mm (range 1.7–2.5 mm). In 3 patients the aneurysms were saccular and one had an unruptured dissecting aneurysm. One saccular aneurysm was treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. The spasm resolved completely in the follow up angiography. One patient that was treated in the acute phase of SAH and required GP 2b3a after the stent was implanted. All patients had good clinical outcomes (mRS <1) including the 1 patient that presented with subarachnoid hemorrhage. Three patients had angiographic follow up (mean 2 months; range 1 to 4 months). No in-stent stenosis or occlusion was seen on the short-term angiographic follow up. In all 3 patients the aneurysms were completely occluded.
Conclusions The use of reconstructive technique in the endovascular treatment of PICA aneurysms using the LVIS Jr stent is feasible, safe and effective in the short-term. Further studies are necessary to address the long-term effectiveness of this device and technique for the treatment of these difficult lesions.
Disclosures G. Dabus: 2; C; Covidien/Medtronic, Microvention/Terumo. 4; C; InNeuroCo, Medina Medical, Surpass/Stryker. E. Samaniego: None.
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