Introduction: The use of the pipeline embolization device(PED) in the posterior circulation has been relatively limited and infrequently reported compared to other off-label utilizations. Posterior Inferior Cerebellar Artery aneurysms (PICAA) constitute one of the least reported posterior circulation aneurysms(PCA) treated with PED. No clinical studies have addressed the treatment of these aneurysms by flow diversion exclusively. We aimed to appraise the feasibility and the safety of PED in the treatment of PICAAs.
Methods: Data on 11 consecutive patients, treated between 2011 and 2017 with PED for their PICAA, was independently reviewed by the authors. To control confounding, we used multivariable logistic regression and propensity score conditioning.
Results: Off 534 patients, 11 (82% males) patients with PICAAs were retrospectively identified and constituted our study population. The average aneurysm size was 8.52mm (SD=2.67, range 3.7-14). Patients were followed-up for an average of 9.6months (SD=6.48months). 18%(2/11) had a prior history of subarachnoid hemorrhage. 8/11 of the aneurysms were Saccular, 2/11 were dissecting, and 1/11 was a small Blister aneurysm. 10/11 aneurysms were treated with 1 PED, only 1 aneurysm necessitated 2 PED for a full neck coverage. 2/11 patients received a combined pipeline assisted coiling. The use of balloon angioplasty was not necessary in any of the treated cases. 1/11 patients had a complete regression and resolution of his aneurysm. 90% had a complete aneurysm occlusion consistent with the modified Raymond-Roy Occlusion Scale. 90% patients did not have any long-term aneurysm recurrence. PED deployment was not complicated with any hemorrhagic or clinically significant thromboembolic events nor with stent migration in any of our patients. 3/11(27%) patients had a benign intra-stent stenosis. No mortality, amongst our 11patients was noted throughout the follow-up period.
Conclusions: PED, shaped and deployed by specialized experts, should be safe in treating PICAA. It can be contemplated as a novel alternative treatment of aneurysms located at the PICA-VA bifurcation or within the PICA.
Patient Care: The use of flow diverters in the posterior circulation is a novel technique to treat posterior circulation aneurysm. It would serve as an alternative option for poor surgical candidates.
Learning Objectives: Flow diverters deployment for the treatment of PICA aneurysms is feasible. With minimal associated morbi-mortality.