Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea.
Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
Medicine (Baltimore). 2021 Dec 17;100(50):e28260. doi: 10.1097/MD.0000000000028260.
Distal posterior inferior cerebellar artery (PICA) aneurysms are extremely rare. Herein, we describe a case of PICA pseudoaneurysm with proximal occlusion achieved using detachable coils, but antegrade recanalization, which showed a normal PICA configuration on follow-up angiography. Possible mechanisms of the recanalization and lesions are also discussed.
The patient was an 80-year-old woman with a subarachnoid hemorrhage (SAH) resulting from a distal PICA-ruptured aneurysm, initially misdiagnosed as a non-aneurysmal traumatic SAH.
On hospitalization day 10, the patient developed rebleeding, and brain computed tomography angiography confirmed a distal PICA pseudoaneurysm.
Endovascular coil embolization was performed. Inevitably, the proximal PICA was occluded using detachable coils, and complete occlusion of the affected PICA was confirmed on the final angiogram.
Fortunately, the patient recovered fully without any neurological sequelae. One year after the procedure, a follow-up angiography was performed, which revealed recanalization of the previously occluded PICA, with normal configuration and no visible aneurysmal dilatation.
Even if the SAH is scanty and predominantly in the perimesencephalic cistern, performing a catheter-based angiography is essential. In the case of proximal occlusion of the parent artery without internal trapping in endovascular treatment of PICA pseudoaneurysm, follow-up examination with a short-term angiography might be crucial.
远外侧后下小脑动脉（PICA）动脉瘤极为罕见。在此，我们描述了一例 PICA 假性动脉瘤病例，采用可解脱弹簧圈实现近端闭塞，但顺行再通，随访血管造影显示 PICA 形态正常。还讨论了再通和病变的可能机制。
患者为 80 岁女性，蛛网膜下腔出血（SAH）源于远端 PICA 破裂性动脉瘤，最初误诊为非动脉瘤性创伤性 SAH。
住院第 10 天，患者再次出血，脑 CT 血管造影证实为远端 PICA 假性动脉瘤。
进行了血管内弹簧圈栓塞。不可避免地，使用可解脱弹簧圈闭塞了近端 PICA，最终血管造影证实受累 PICA 完全闭塞。
幸运的是，患者完全康复，无任何神经后遗症。术后 1 年进行了随访血管造影，显示先前闭塞的 PICA 再通，形态正常，未见可见的动脉瘤扩张。
即使出血量少且主要位于间脑周围池，进行基于导管的血管造影也是必要的。对于 PICA 假性动脉瘤血管内治疗中近端母动脉闭塞且无内部捕获的情况，进行短期血管造影随访可能至关重要。
