The major consideration including preservation of the PICA and complete occlusion of the aneurysm ( 7). However, Treatment of vertebral artery aneurysm involving PICA is challenging. Previous study reported that PICA involvement is risk factor of progression ( 5), and it has the highest morbidity among the ruptured vertebral artery aneurysm ( 6). Therefore, it is necessary to take more aggressive treatment for the unruptured vertebral artery aneurysm considering the risk of progression and rupture, especially vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA). The outcome of ruptured vertebral artery aneurysm is dismay with a high mortality rate of up to 50% ( 4). Vertebral artery aneurysm account for 11% of posterior circulation aneurysms and 3–5% of subarachnoid hemorrhage (SAH) ( 1– 3). At a mean of 20.7 months (range 7–50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit.Ĭonclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA. The two occlusions of PICA were secondary to PAO. Parent artery occlusion (PAO) was occurred in 3 patients (10%). Images were available in 30 patients (93.8%) during a period of 3–26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed. Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA. The experience of pipeline embolization device (PED) therapy for these lesions is still limited. 2Department of Neurosurgery, Fushun Central Hospital, Fushun, Chinaīackground: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging.1Department of Interventional Neuroradiology, Bejing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Weiqi Fu 1,2 Huijian Ge 1 Gang Luo 1 Xiangyu Meng 1 Jiejun Wang 1 Hengwei Jin 1 * † Youxiang Li 1 * †
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