Antegrade recanalization of parent artery in proximal occlusion of distal posterior inferior cerebellar artery ruptured aneurysm: A case report. Issue 50 (17th December 2021)

• Record Type: Journal Article
• Authors: Jang, Hyung-Gyu; Park, Jung-Soo
• Editors: Saranathan., Maya
• Is Part Of: Medicine. Volume 100:Issue 50(2021)
• Page Start: e28260
• Publication Date: 2021-12-17
• Subjects: aneurysm -- angiography -- posterior inferior cerebellar artery; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000028260
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Distal posterior inferior cerebellar artery (PICA) aneurysms are extremely rare. Herein, we describe a case of PICA pseudoaneurysm with proximal occlusion achieved using detachable coils, but antegrade recanalization, which showed a normal PICA configuration on follow-up angiography. Possible mechanisms of the recanalization and lesions are also discussed. Patient concerns: The patient was an 80-year-old woman with a subarachnoid hemorrhage (SAH) resulting from a distal PICA-ruptured aneurysm, initially misdiagnosed as a non-aneurysmal traumatic SAH. Diagnosis: On hospitalization day 10, the patient developed rebleeding, and brain computed tomography angiography confirmed a distal PICA pseudoaneurysm. Intervention: Endovascular coil embolization was performed. Inevitably, the proximal PICA was occluded using detachable coils, and complete occlusion of the affected PICA was confirmed on the final angiogram. Outcome: Fortunately, the patient recovered fully without any neurological sequelae. One year after the procedure, a follow-up angiography was performed, which revealed recanalization of the previously occluded PICA, with normal configuration and no visible aneurysmal dilatation. Conclusion: Even if the SAH is scanty and predominantly in the perimesencephalic cistern, performing a catheter-based angiography is essential. In the case of proximal occlusion of the parent artery without internal trapping in endovascular treatment of PICA pseudoaneurysm, follow-up examination with a short-term angiography might be crucial.