Coiling of an iatrogenic aneurysm of the distal posterior inferior cerebellar artery via a Marathon microcatheter

Abstract

Iatrogenic distal posterior inferior cerebellar artery (PICA) aneurysms are rare, and parent artery occlusion (PAO) via Marathon microcatheters can be an option for coiling. We reported such a case. A 60-year-old woman with an epidermoid cyst of the posterior fossa suffered subarachnoid hemorrhage after open surgery for the removal of an epidermoid cyst and fell into a coma. Digital subtraction angiography confirmed a distal PICA iatrogenic dissecting aneurysm. Due to the PICA being tortuous, routine microcatheters that deliver coils cannot access the aneurysm. However, a Marathon microcatheter over a Synchro 10 guidewire was able to successfully access the aneurysm. An Axium Prime coil was advanced easily into a Marathon microcatheter. After the coil was detached in the Marathon microcatheter, the Synchro 10 guidewire was able to push the detached coil through the Marathon microcatheter tip into the dissecting aneurysm, and then another coil was deployed to complete PAO. Postoperatively, due to acute hydrocephalus, an Ommaya catheter with a reservoir was deployed into the lateral ventricle to aspirate cerebrospinal fluid. One week postoperatively, a computed tomography scan showed acute infarction of the cerebellar hemisphere with no mass effect. During follow-up, no rebleeding occurred. Six months later, the patient did not wake up and was declared to be in a vegetative state. By reporting this case, it was found that for iatrogenic distal PICA aneurysms, PAO is feasible with an Axium Prime coil deployed via a Marathon microcatheter.