Basamh Mohammed, Costa Matias, Pierre Clifford, Goren Oded, Alomar Soha, Young Mitchell, Patel Akshal, Monteith Stephen, Loh Yince
Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, WA, USA.
Interv Neuroradiol. 2025 May 13:15910199251341028. doi: 10.1177/15910199251341028.
ObjectivePosterior inferior cerebellar artery (PICA) aneurysms are uncommon and may be challenging to treat, especially if they are very small saccular or dissecting pseudoaneurysms at proximal and mid-PICA locations. They are usually technically difficult to treat with conventional reconstructive endovascular methods. We present our experience with PICA aneurysms treated by a stand-alone small, low-profile stent with a moderate flow-diverting effect (low-profile visualized intraluminal support junior (LVIS Jr)) compared to conventional endovascular methods.MethodsSingle institution cases of treated unruptured PICA aneurysms from 2015 to May 2022 were retrospectively reviewed. Patient characteristics, pre-and postoperative images, and last clinical and radiological outcomes were analyzed. Comparative statistical analysis was used.ResultsNine cases of unruptured PICA aneurysms treated with stand-alone LVIS Jr (group 1) and seven cases treated with other conventional methods (group 2) were identified. The mean age was 56 versus 61.43 years, sex was female in 7 versus 6 cases, and the left side was involved in 7 versus 4 cases in group 1 and group 2, respectively. All aneurysms were in the proximal PICA segment except for one case in the mid-PICA segment aneurysm in each group. There was a difference in aneurysm type in both groups ( = 0.008). All aneurysms were of saccular type except for five dissecting types in group 1 and 2 in group 2. The mean aneurysm size was 1.91 ± 0.62 in group 1 and 9.04 ± 5.82 mm in group 2 ( < 0.0002). In group 2, treatment was with PICA sacrifice (one case), primary aneurysm coiling (three cases), stent-assisted coiling (one case), and flow diverter (two cases). Complications were only puncture site-related that occurred once in each group. There were no differences in mean clinical or radiological follow-up. Aneurysm recurrence with retreatment occurred in two cases in each group. All patients had an mRS 0-2 at the last follow-up.ConclusionIn selected cases, unruptured small or dissecting PICA aneurysms may be treated safely and effectively using single stand-alone LVIS Jr. Prospective studies are needed to validate safety and efficacy.
目的
小脑后下动脉（PICA）动脉瘤并不常见，治疗可能具有挑战性，尤其是当它们是位于PICA近端和中段的非常小的囊状或夹层假性动脉瘤时。用传统的重建性血管内方法治疗它们通常在技术上很困难。我们介绍了与传统血管内方法相比，使用具有适度血流导向作用的独立小型、低轮廓支架（低轮廓可视化腔内支撑 junior，LVIS Jr）治疗PICA动脉瘤的经验。
方法
回顾性分析2015年至2022年5月在单一机构治疗的未破裂PICA动脉瘤病例。分析患者特征、术前和术后图像以及最后的临床和放射学结果。采用比较统计分析。
结果
确定了9例用独立LVIS Jr治疗的未破裂PICA动脉瘤（第1组）和7例用其他传统方法治疗的病例（第2组）。第1组和第2组的平均年龄分别为56岁和61.43岁，女性分别为7例和6例，左侧受累分别为7例和4例。除每组各有1例位于PICA中段动脉瘤外，所有动脉瘤均位于PICA近端段。两组的动脉瘤类型存在差异（P = 0.008）。除第1组有5例夹层型和第2组有2例夹层型外，所有动脉瘤均为囊状型。第1组的平均动脉瘤大小为1.91±0.62mm，第2组为9.04±5.82mm（P < 0.0002）。在第2组中，治疗方法包括PICA牺牲术（1例）、原发性动脉瘤栓塞术（3例）、支架辅助栓塞术（1例）和血流导向装置（2例）。并发症仅与穿刺部位有关，每组各发生1次。平均临床或放射学随访无差异。每组各有2例患者再次治疗时出现动脉瘤复发。所有患者在最后一次随访时改良Rankin量表（mRS）评分为0 - 2分。
结论
在选定的病例中，使用单一独立的LVIS Jr可以安全有效地治疗未破裂的小型或夹层PICA动脉瘤。需要进行前瞻性研究来验证安全性和有效性。
