Ruptured Isolated Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery Treated with Overlap Stenting Using LVIS Jr.: A Case Report

• Published in: Surgery for Cerebral Stroke Vol. 51; no. 5; pp. 417 - 422
• Main Authors: UZURA, Yasunori, NANTO, Masataka, MIYAMOTO, Junichi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society on Surgery for Cerebral Stroke 2023
• Subjects: deconstructive treatment; overlap stenting; posterior inferior cerebellar artery; reconstructive treatment; ruptured isolated dissecting aneurysm
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs.51.417

We report a case of a ruptured isolated dissecting aneurysm of the posterior inferior cerebellar artery (PICA). A 74-year-old woman presented with a sudden disturbance of consciousness. Computed tomography (CT) of the head revealed a massive subarachnoid hemorrhage (SAH) in the basal cistern. Digital subtraction angiography (DSA) revealed a dissecting fusiform aneurysm of 3.0 mm in diameter in the lateral medullary segment of the left PICA. Embolization of the aneurysm using a coil is challenging because of its small size. LVIS Jr. overlap stenting was preferred over parent artery occlusion owing to the risk of brainstem infarction for the rectification effect. The patient reported temporary hoarseness postoperatively; however, a modified Rankin scale score of 0 was observed at discharge. A follow-up DSA performed after 4 weeks revealed the absence of an aneurysm, which did not recur until 3 months. Ruptured isolated dissecting aneurysms of PICA are rare, and accounting for 0.5–2.2% of all intracranial aneurysms, have a high re-bleeding rate, and are prone to complications associated with deconstructive treatments. Reconstructive surgery is associated with fewer complications. However, in this case, because of the small size of the fusiform aneurysm, reconstructive treatment was not recommended. Overlap stenting is effective in treating aneurysms in different regions owing to its rectification effect. Hence, we performed overlap stenting using LVIS Jr., which showed good short- and mid-term outcomes. To date, no study has reported overlap stenting of LVIS Jr. for ruptured isolated dissecting aneurysms of the PICA. Therefore, our study contributes to increasing knowledge of effective treatment modalities for this rare type of aneurysm.