Endovascular Coiling of Ruptured Very Small Dissecting Fusiform Aneurysm of Posterior Inferior Cerebellar Artery with Parent Artery Preservation by Microcatheter Auto-Assistance

BACKGROUND: Aneurysmal subarachnoid hemorrhage secondary to ruptured small dissecting fusiform aneurysms of the posterior inferior cerebellar artery (PICA) is rare and particularly challenging. Different treatment strategies have been reported in these rare cases. We report 2 patients treated with a novel endovascular approach. CASE DESCRIPTION: Two patients presented with subarachnoid hemorrhage secondary to very small (3 mm and 4 mm) ruptured fusiform aneurysms of the proximal section of the PICA trunk. Both patients were treated by coil embolization combined with parent artery preservation by microcatheter autoassistance. Both coiling procedures were uneventful, and the patients remained asymptomatic. Long-term follow-up angiography in both patients showed complete occlusion of aneurysms with patency of PICA. CONCLUSIONS: There is no single treatment strategy suitable for all PICA aneurysms. Our proposed method may be best applied to small dissecting fusiform aneurysms located on a small (<= 1 mm in diameter) PICA distally to its origin.