Stand-alone small low-profile braided stents for challenging unruptured posterior inferior cerebellar artery aneurysms compared to conventional endovascular methods: A cohort study.

ObjectivePosterior inferior cerebellar artery (PICA) aneurysms are uncommon and may be challenging to treat, especially if they are very small saccular or dissecting pseudoaneurysms at proximal and mid-PICA locations. They are usually technically difficult to treat with conventional reconstructive endovascular methods. We present our experience with PICA aneurysms treated by a stand-alone small, low-profile stent with a moderate flow-diverting effect (low-profile visualized intraluminal support junior (LVIS Jr)) compared to conventional endovascular methods.MethodsSingle institution cases of treated unruptured PICA aneurysms from 2015 to May 2022 were retrospectively reviewed. Patient characteristics, pre-and postoperative images, and last clinical and radiological outcomes were analyzed. Comparative statistical analysis was used.ResultsNine cases of unruptured PICA aneurysms treated with stand-alone LVIS Jr (group 1) and seven cases treated with other conventional methods (group 2) were identified. The mean age was 56 versus 61.43 years, sex was female in 7 versus 6 cases, and the left side was involved in 7 versus 4 cases in group 1 and group 2, respectively. All aneurysms were in the proximal PICA segment except for one case in the mid-PICA segment aneurysm in each group. There was a difference in aneurysm type in both groups (p = 0.008). All aneurysms were of saccular type except for five dissecting types in group 1 and 2 in group 2. The mean aneurysm size was 1.91 ± 0.62 in group 1 and 9.04 ± 5.82 mm in group 2 (p < 0.0002). In group 2, treatment was with PICA sacrifice (one case), primary aneurysm coiling (three cases), stent-assisted coiling (one case), and flow diverter (two cases). Complications were only puncture site-related that occurred once in each group. There were no differences in mean clinical or radiological follow-up. Aneurysm recurrence with retreatment occurred in two cases in each group. All patients had an mRS 0-2 at the last follow-up.ConclusionIn selected cases, unruptured small or dissecting PICA aneurysms may be treated safely and effectively using single stand-alone LVIS Jr. Prospective studies are needed to validate safety and efficacy.