Illustrated step-by-step guide to stent-assisted coiling of wide-neck posterior inferior cerebellar aneurysm via a contralateral vertebral artery approach

Abstract

Background and Objectives

Posterior inferior cerebellar artery (PICA) aneurysms are uncommon, occurring in 0.5% to 3% of all intracranial aneurysms. Due to the distinct anatomy and varying geometrical configuration at the PICA origin, endovascular treatment can be challenging. The contralateral vertebral artery approach to these aneurysms may provide a more advantageous route for endovascular treatment. We describe a series of eight cases of contralateral vertebral artery (VA) approach for stent-assisted coiling of PICA aneurysms.

Methods

We performed a retrospective review of all patients from 2013 in our center who were diagnosed with PICA aneurysm and treated with stent-assisted coiling using a contralateral VA approach. Our study was conducted under the Institutional Review Board (IRB) at our institution, and informed consent was obtained from all patients prior to the procedures. Patient characteristics, angiographic studies, and clinical course were reviewed.

Results

Eight patients were included with a median age of 53 [IQR; 48–62]. Five patients (62.5%) had another aneurysm in addition to PICA. Three (37.5%) aneurysms had previously undergone primary coil embolization. The remaining five patients (62.5%) were index treatments. Transfemoral approach (TFA) was used in 7 patients and transradial approach (TRA) was used in 1 patient. The immediate Raymond Roy occlusion (RROC) was I (25%), II (50%) and III (25%). Follow-up RROC (range 6–12 months) were improved to class I in the majority (62.5%) and none were III.

Conclusions

Stent-assisted coiling via contralateral vertebral artery approach is an effective technique for PICA aneurysm treatment with favorable follow up occlusion rate.