Posterior Inferior Cerebellar Artery Aneurysm: Ruptured Posterior Inferior Cerebellar Artery Aneurysm, Treated with Coil Occlusion, Presenting Delayed Cerebral Vasospasm, Treated with the pRELAX Vasospasm Treatment Device

Abstract

We present the case of a 60-year-old woman who had a spontaneous SAH due to a ruptured right-hand posterior inferior cerebellar artery (PICA) aneurysm, which was treated with coils. Fourteen days later while in the intensive care unit, the patient became disorientated and developed severe hemiparesis on the left-hand side. Focal proximal bilateral vasospasm was observed in transcranial Doppler examination, after which digital subtraction angiography (DSA) was immediately carried out. After bilateral severe proximal vasospasm was confirmed, the patient was treated with a pRELAX vasospasm treatment device (femtos GmbH) with good angiographic results and improvement in her neurologic status.

The management of cerebral vasospasm (CVS) due to aneurysmal subarachnoid hemorrhage (aSAH) is an old, feared challenge, persisting to the present day. Medical clinical treatment of vasospasm has evolved from the classical triple-H therapy (hypertension, hypervolemia, and hemodilution) to the relationship between nimodipine and hypertension. However, despite concerted efforts to prevent the worst outcome, approximately 30% of patients will go on to develop neurological deficits, termed “symptomatic vasospasm.” In order to prevent and reduce long-term neurologic morbidity, endovascular treatment is recommended for patients with medically refractory vasospasm in the territory of a major cerebral artery. Currently, the most commonly used endovascular therapy options include intra-arterial vasodilator infusion, and balloon angioplasty, even though the use of the stent retriever technique to achieve long-lasting vasodilation is progressively showing itself to be more advantageous. The treatment of post-hemorrhagic, severe vasospasm and the use of the pRELAX vasospasm treatment device in comparison to other endovascular techniques are the main topics of this chapter.