Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Endovascular treatment for anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk variant aneurysms: Technical note and literature review

  • Jerry C. Ku (Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto) ;
  • Vishal Chavda (Department of Pathology, Stanford School of Medicine, Stanford University Medical Centre) ;
  • Paolo Palmisciano (Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital) ;
  • Christopher R. Pasarikovski (Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto) ;
  • Victor X.D. Yang (Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto) ;
  • Ruba Kiwan (Department of Radiology, Health Sciences North, Northern Ontario School of Medicine University) ;
  • Stefano M. Priola (Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University) ;
  • Bipin Chaurasia (Department of Neurosurgery, Neurosurgery Clinic)
  • Received : 2022.10.24
  • Accepted : 2023.02.26
  • Published : 2023.12.31
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Abstract

The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) common trunk is a rare variant of cerebral posterior circulation in which a single vessel originating from either the basilar or vertebral arteries supplies both cerebellum and brainstem territories. We present the first case of an unruptured right AICA-PICA aneurysm treated with flow diversion using a Shield-enhanced pipeline endovascular device (PED, VANTAGE Embolization Device with Shield Technology, Medtronic, Canada). We expand on this anatomic variant and review the relevant literature. A 39-year-old man presented to our treatment center with vertigo and right hypoacusis. The initial head CT/CTA was negative, but a 4-month follow-up MRI revealed a 9 mm fusiform dissecting aneurysm of the right AICA. The patient underwent a repeat head CTA and cerebral angiogram, which demonstrated the presence of an aneurysm on the proximal portion of an AICA-PICA anatomical variant. This was treated with an endovascular approach that included flow diversion via a PED equipped with Shield Technology. The patient's post-procedure period was uneventful, and he was discharged home after two days with an intact neurological status. The patient is still asymptomatic after a 7-month follow-up, with MR angiogram evidence of stable aneurysm obliteration and no ischemic lesions. Aneurysms of the AICA-PICA common trunk variants have a high morbidity risk due to the importance and extent of the territory vascularized by a single vessel. Endovascular treatment with flow diversion proved to be both safe and effective in obliterating unruptured cases.

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References

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