A Case of an Vertebral Artery Dissecting Aneurysm Involving the Posterior Inferior Cerebellar Artery Treated With Aneurysmal Embolization and Proximal Parent Artery Occlusion Under Balloon Protection via the Contralateral Vertebral Artery

TL;DR

A new endovascular technique successfully treated a complex vertebral artery aneurysm while preserving a critical brain artery.

Contribution

A novel balloon-protected embolization technique for vertebral artery dissecting aneurysms involving the PICA is introduced.

Findings

A successful treatment of a vertebral artery dissecting aneurysm was achieved using balloon protection and coil embolization.

The technique preserved the posterior inferior cerebellar artery without stent-related complications.

This approach may offer a safer alternative for complex aneurysms involving the PICA.

Abstract

We experienced a case of subarachnoid hemorrhage due to a rupture of a vertebral artery dissecting aneurysm (VADA) involving the posterior inferior cerebellar artery (PICA) treated with a novel endovascular technique, which used a balloon catheter to protect the PICA origin via the contralateral vertebral artery. We performed coil embolization of the VADA and proximal parent artery occlusion via the ipsilateral vertebral artery under protection of the PICA. Using a balloon catheter instead of a stent, dense packing was achieved while preserving the PICA and avoiding hemorrhagic complications with stent-related antiplatelet therapy. Although further assessment is needed to clarify the potential risks and limitations, this technique can be a useful treatment option for VADA involving the PICA.

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