Korean J Radiol.  2012 Aug;13(4):510-514. 10.3348/kjr.2012.13.4.510.

Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm

• Roh HG
• Chun YI
• Choi JW
• Cho J
• Moon WJ
• Solander S

• KMID: 1383866
• DOI: http://doi.org/10.3348/kjr.2012.13.4.510

Abstract

Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.

Keyword

Posterior inferior cerebellar artery; Aneurysm; Endovascular treatment; Retrograde stenting; Enterprise stent

MeSH Terms

Cerebellar Diseases/radiography/*therapy
Cerebral Angiography
Embolization, Therapeutic/instrumentation/*methods
Humans
Intracranial Aneurysm/radiography/*therapy
Male
Middle Aged
*Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Retrograde stenting through contralateral vertebral artery for wide-necked posterior inferior cerebellar artery (PICA) aneurysm. A, B. Oblique lateral view of left vertebral arteriogram (A) and oblique anteroposterior view of right vertebral angiogram (B) demonstrated wide-necked aneurysm with medially directed distal lobule (arrow) at left PICA origin. Left PICA had downward course forming acute angle with proximal intracranial vertebral artery (bent arrow in A), and both vertebral arteries formed acute angle at vertebrobasilar junction (bent arrow in B). C. Prowler Select LP microcatheter was advanced into contralateral, right distal vertebral artery and navigated retrogradely into left distal vertebral artery through "acute-angled" vertebrobasilar junction with help of J-shaped microcatheter tip (arrow). D. Using exchangeable guidewire, Prowler Plus Select microcatheter was advanced into left distal PICA across aneurysm neck for stent delivery. E. Enterprise stent (4.5 × 22 mm) was advanced into left distal vertebral artery-PICA and placed below aneurysm neck. Before stent deployment, another microcatheter was placed within aneurysm through ipsilateral guiding catheter in left vertebral artery for coiling. After partial coiling (arrow) of aneurysm, stent was deployed from the proximal PICA to distal vertebral artery. F. Final control angiogram showed near-complete occlusion of aneurysm and preservation of PICA and vertebral artery flow. G. Follow-up angiogram 11 months after embolization revealed complete occlusion of aneurysm.

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