![]() All patients had heparinization (activated clotting time, >300) immediately after or during EVT, and heparinization was maintained for 24 hours after the procedure. In 6 patients with SAH, EVT was attempted immediately after diagnostic angiography, and in 3 patients, electively. The endovascular treatment option was decided on the basis of discussion between a neurosurgeon and interventional neuroradiologist regarding the patient's condition, the anticipated clinical outcome, and the surgical difficulty associated with the size and location of the aneurysm.ĮVT was attempted in all patients with the patients under general anesthesia. In all patients, a diagnostic cerebral angiogram was obtained before the endovascular procedure to evaluate the associated vascular anatomy of the posterior circulation and define the underlying vascular disease. Five aneurysms were associated with the AICA-PICA variant, and 2 aneurysms, with Moyamoya disease or arteriovenous malformation. 6, 26 According to this classification, the location of aneurysms was as follows: the proximal AICA in 7 and the distal AICA in 2. All the involved aneurysms were of the saccular type, varying from 3 to 15 mm in the largest diameter.ĪICA aneurysms are classified as proximal (from the BA-AICA junction to the AICA bifurcation or a combined AICA-PICA origin, premeatal segment) and distal (from the end of the meatal loop to the distal AICA, postmeatal segment) with reference to the seventh and eighth cranial nerve complex. According to the HH, grades III-IV were reported in 5 patients and grade I, in 1. Six patients presented with SAH, and 3 aneurysms were found incidentally. We present our experience in the treatment and the clinical outcome of AICA aneurysms using EVT. 22 – 24 Recently Kusaka et al 25 reported coil embolization of an AICA aneurysm with preservation of the parent artery. 9 – 21 Although various surgical approaches have been introduced to access these aneurysms, surgical treatment is often limited due to the complexity of the adjacent neurovascular structure, the presence of brain stem perforators, the narrow and deep surgical field, and the necessity of an experienced surgeon.Īlthough EVT has been reported for the treatment of AICA aneurysms, the most common procedure is parent artery occlusion. Since the first surgery of an AICA aneurysm by Schwartz, 8 dozens of case reports and some articles have been published concerning surgical treatment of AICA aneurysms. 1 – 7 These aneurysms are a therapeutic challenge, with high surgical risk. Abbreviations AICA anterior inferior cerebellar artery AVM arteriovenous malformation BA basilar artery CO complete occlusion Cx procedural complication EVD external ventricular drainage EVT endovascular therapy F/U follow-up period HH Hunt and Hess scale IO incomplete occlusion mRS modified Rankin Scale NA not available O occlusion P preservation PICA posterior inferior cerebellar artery SAH subarachnoid hemorrhage TIA transient ischemic accident Tx treatment VA vertebral arteryĪICA aneurysms are extremely rare and account for less than 1.5% of all intracranial aneurysms. ![]()
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