Abstract

Unlike the most of the aneurysms of posterior circulation, PICA aneurysms more often are subject of microsurgery than endovascular technique. Being relatively rare in population, this type of lesions is exceptionally challenging for any type of treatment. PICA aneurysms often present as dissecting, fusiform, small or blister-like lesions. Classical saccular form is less common here comparing to other locations. At the same time, both natural history and post-treatment morbidity/mortality is more aggressive for ruptured PICA aneurysms comparing to other locations. However, we suppose there is potential to improve the outcomes. Evaluated recent reports and our own experience we suggest that there is no unique recommendation whether clipping or coiling is better for this location. Despite the rarity of these lesions, we split them to even more rare types and discussing precisely specific approaches to each of them. Our conclusion is that there is unique key-option for any difficult and challenging PICA aneurysm and we suggest that this approach might have potential to improve outcomes for these lesions.