Posterior Inferior Cerebellar Artery Aneurysm: Multiple Incidental Aneurysms of Both MCAs and the Left Vertebral Artery, Surgical Clipping of two Right MCA Aneurysms, and Flow Diversion Using the Slipstream Effect of the Left PICA and Left M1 Aneurysm
A 51-year-old female patient underwent a MRI/MRA examination as workup for non-specific, occasional discomfort. Small incidental aneurysms of both middle cerebral arteries (MCAs) were found in December 2012 and in June 2013. A diagnostic DSA in November 2013 showed four intradural aneurysms: #1 a fusiform dilatation of the inferior trunk of the right MCA, #2 an aneurysm of the superior trunk of the right MCA with a 4 mm neck width and 3 mm depth and a small daughter aneurysm, #3 a small aneurysm of the left MCA/M1 segment at the origin of the second temporal branch with a fundus diameter of 3 mm, and #4 an aneurysm of the left vertebral artery (VA)/V4 segment at the origin of the left posterior inferior cerebellar artery (PICA) with a fundus diameter of 2 mm. The two right-sided MCA aneurysms were surgically clipped. The aneurysms on the left M1 segment and on the left PICA were treated by flow diversion (p64). Due to the small caliber of the parent arteries (the second temporal branch of the left MCA and the left PICA), the flow diverters were implanted in the adjacent main arteries (the left M1 segment and the left V4 segment), covering the orifice of the branching vessel rather than the entire neck of the aneurysm. Both aneurysms regressed completely during the following months. The treatment of intracranial aneurysms using the slipstream effect of flow diverters is the main topic of this chapter.
KeywordsMiddle cerebral artery PICA Flow diversion p64 Slipstream effect Hyperresponse to antiplatelet medication
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