Posterior Inferior Cerebellar Artery Aneurysm: Incidental Wide-Neck Aneurysm, Incorporation of the PICA, and Treatment with a Single 3D Coil and a p64 Flow Diverter
A medium-sized incidental aneurysm of the left vertebral artery and the posterior inferior cerebellar artery was treated by endovascular insertion of a single 3D coil and subsequent coverage with a p64 (phenox) flow diverter, using jailed catheter technique. Angiography after two weeks confirmed the obliteration of the aneurysm while the posterior inferior cerebellar artery remained patent. This case illustrates the benefit of partial coil occlusion, the phenomenon of transient (minor) in-stent stenosis, and the intended flow diverting effect with obliteration of the aneurysm without compromise of an adjacent side branch. Flow diversion, as a treatment modality for saccular sidewall aneurysms, is frequently technically easier than balloon- or stent-assisted coil occlusion. A potential issue after coil occlusion is the recurrent perfusion of the aneurysm due to coil compaction, secondary aneurysm growth, and coil migration into an intrasaccular thrombus. Once a saccular aneurysm has been completely occluded under the influence of an extrasaccular flow-diverting device, recurrence of this aneurysm is very unlikely. The combination of partial coil occlusion together with extrasaccular flow diversion is the main topic of this report.
KeywordsPICA Saccular aneurysm 3D coil Flow diversion p64
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