Ismail Mustafa, Kinjo Norito, Al-Taie Rania H, Spiotta Alejandro M
Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, 29403, USA.
Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq.
Neurosurg Rev. 2025 Jul 1;48(1):534. doi: 10.1007/s10143-025-03694-9.
Vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) origin present a unique therapeutic challenge due to high rupture risk, complex anatomy, and the critical need to preserve brainstem perfusion. Despite the increasing use of endovascular strategies, no prior meta-analysis has specifically evaluated outcomes for this clinically high-risk subgroup.
To systematically review and quantitatively synthesize available data on the endovascular management of VADAs involving the PICA origin.
A comprehensive literature search of PubMed and Scopus was conducted per PRISMA guidelines. Studies reporting clinical outcomes for VADAs involving the PICA origin treated with endovascular techniques were included. Pooled estimates were calculated for key outcomes using a random-effects meta-analysis model. Heterogeneity and publication bias were assessed.
This review included 141 patients. The majority (90.1%) presented with ruptured aneurysms. In the literature, stent-assisted coiling (SAC) was the most frequently employed reconstructive strategy, with a 12.5% recurrence rate (95% CI: 6-24%) and a 20% rebleeding rate (95% CI: 12-38%, p < 0.001) according to one-arm proportional meta-analysis. The overall complete occlusion following endovascular therapy was 49.2% (95% CI: 94-100%). PICA patency was preserved in 43.7% of cases. The overall ischemic complication rate was 15.6%, and mortality was 6.4%, predominantly in patients undergoing deconstructive treatments. Most patients achieved favorable neurological outcomes (mRS ≤ 2).
Flow diversion appears to be a promising option for PICA-involving VADAs, demonstrating comparable early occlusion rates with no reported re-bleeding in the limited cases available, and a lower tendency to recur compared with SAC. SAC retains value in anatomically favorable, nondominant lesions, though its higher rebleeding risk limits its use when branch hemodynamics are complex. Larger, prospective multicenter studies are needed to refine flow-diverter protocols and define the specific circumstances in which adjunctive or stent-assisted techniques remain advantageous.
Not applicable.
累及小脑后下动脉（PICA）起始部的椎动脉夹层动脉瘤（VADA）因破裂风险高、解剖结构复杂以及维持脑干灌注的迫切需求而带来独特的治疗挑战。尽管血管内治疗策略的应用日益增多，但此前尚无荟萃分析专门评估这一临床高危亚组的治疗结果。
系统回顾并定量综合有关累及PICA起始部的VADA血管内治疗的现有数据。
按照PRISMA指南对PubMed和Scopus进行全面文献检索。纳入报告采用血管内技术治疗累及PICA起始部的VADA临床结果的研究。使用随机效应荟萃分析模型计算关键结果的合并估计值。评估异质性和发表偏倚。
本综述纳入141例患者。大多数（90.1%）为破裂动脉瘤。在文献中，支架辅助弹簧圈栓塞（SAC）是最常用的重建策略，根据单臂比例荟萃分析，复发率为12.5%（95%CI：6-24%），再出血率为20%（95%CI：12-38%，p<0.001）。血管内治疗后的总体完全闭塞率为49.2%（95%CI：94-100%）。43.7%的病例保留了PICA通畅。总体缺血并发症发生率为15.6%，死亡率为6.4%，主要发生在接受解构性治疗的患者中。大多数患者获得了良好的神经功能结局（改良Rankin量表评分≤2）。
血流导向似乎是治疗累及PICA的VADA的一个有前景的选择，在有限的可用病例中显示出可比的早期闭塞率，且未报告再出血，与SAC相比复发倾向较低。SAC在解剖结构有利的非优势病变中仍有价值，但其较高的再出血风险限制了其在分支血流动力学复杂时的应用。需要开展更大规模的前瞻性多中心研究，以完善血流导向方案，并确定辅助或支架辅助技术仍具优势的具体情况。
不适用。
