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Dissecting distal cerebellar artery aneurysms: options beyond a parent vessel sacrifice

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Abstract

Parent vessel occlusion (PVO) is the conventional endovascular treatment (EVT) for dissecting distal cerebellar artery aneurysms (DCAA). The associated ischemic sequelae are often well-tolerated. However, at the outset, the magnitude of this risk is uncertain. Meanwhile, non-PVO endovascular treatments (EVT) are deemed to provide incomplete protection from a rebleed. This study reviews our experience in the management of dissecting DCAA with emphasis on the effectiveness of parent vessel-preserving endovascular strategies as compared to PVO. Our institutional database was reviewed for all the dissecting DCAA aneurysms treated by endovascular means between Nov 2015 and Oct 2018. Their clinical presentations, imaging findings, EVT techniques, and clinical outcomes were retrospectively evaluated. Eighteen dissecting DCAA were identified: 13 in the posterior-inferior cerebellar artery (PICA), 3 in anterior-inferior cerebellar artery (AICA), and 2 in superior cerebellar artery (SCA). Median patient age was 61 years (range 40–86; average 60.7 years) with a 5:1 female predominance. Nine (6 in the PICA and 3 in the AICA) patients were managed by parent vessel-preserving strategies (6 with isolated endosaccular coiling and 3 with telescoping stents) while the remaining 9 (7 in the PICA and 2 in the SCA) were treated by PVO.

The frequency of early rebleed was the same (11%) in both the treatment arms. One patient from the PVO arm suffered an extensive cerebellar infarct that mandated decompressive craniectomy and adversely affected her recovery. There were no such complications in patients treated with parent vessel-preserving strategies. No recurrence/rebleed was encountered in the 3 aneurysms secured using telescoping stents. Overall, excellent clinical outcomes (mRS of 0 and 1) were sparsely seen in the patients who had PVO (89 vs 23%). In dissecting DCAA, aforedescribed, parent vessel-preserving strategies are as effective as the more frequently used option of PVO in preventing an early rebleed. However, these are technically challenging, may be feasible in a smaller proportion of patients, and would need meticulous imaging follow-up in the acute period. When successfully implemented, these strategies can deliver excellent clinical outcomes and eliminate the uncertain risk of ischemic complications associated with PVO.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Gopinathan Anil

  2. Division of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Lwin Sein, Vincent Nga, Kejia Teo, Ning Chou & Tseng Tsai Yeo

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  1. Gopinathan Anil
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  2. Lwin Sein
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  3. Vincent Nga
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  4. Kejia Teo
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  6. Tseng Tsai Yeo
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Correspondence to Gopinathan Anil.

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Conflict of interest

In the last 2 years, Dr. Anil Gopinathan has served as a consultant and proctor for Medtronic and Stryker Neurovascular as well as Penumbra Inc. The rest of the authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Approval was obtained from the institutional review board for ethics.

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“Waiver of consent” was obtained from the ethics committee for this retrospective study.

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Anil, G., Sein, L., Nga, V. et al. Dissecting distal cerebellar artery aneurysms: options beyond a parent vessel sacrifice. Neurosurg Rev 43, 771–780 (2020). https://doi.org/10.1007/s10143-019-01119-y

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  • DOI: https://doi.org/10.1007/s10143-019-01119-y

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