Posterior Inferior Cerebellar Artery Aneurysm: Incidental Wide-Neck Aneurysm, Incorporation of the PICA, and Treatment with a Single 3D Coil and a p64 Flow Diverter

Abstract

A medium-sized incidental aneurysm of the left vertebral artery and the posterior inferior cerebellar artery was treated by endovascular insertion of a single 3D coil and subsequent coverage with a p64 (phenox) flow diverter, using jailed catheter technique. Angiography after 2 weeks confirmed the obliteration of the aneurysm while the posterior inferior cerebellar artery remained patent. This case illustrates the benefit of partial coil occlusion, the phenomenon of transient (minor) in-stent stenosis, and the intended flow diverting effect with obliteration of the aneurysm without compromise of an adjacent side branch. Flow diversion, as a treatment modality for saccular sidewall aneurysms, is frequently technically easier than balloon- or stent-assisted coil occlusion. A potential issue after coil occlusion is the recurrent perfusion of the aneurysm due to coil compaction, secondary aneurysm growth, and coil migration into an intrasaccular thrombus. Once a saccular aneurysm has been completely occluded under the influence of an extrasaccular flow-diverting device, recurrence of this aneurysm is very unlikely. The combination of partial coil occlusion together with extrasaccular flow diversion is the main topic of this report.