9/26/2023 0 Comments Pica artery surgeryDuring thoracic endovascular aortic repair with Zone-2 proximal landing, debranching bypass was employed to preserve left subclavian perfusion when there was PICA termination, hypoplasia or occlusive lesion. In aortic arch replacement, these were reconstructed together with the left subclavian artery while hypothermia was maintained. Two of the seven arch-originated arteries terminated in the PICA. There were 19 hypoplasia (12%), 10 PICA termination (6%) and 12 occlusive lesion (8%) on the right vertebral artery and 10 hypoplasia (6%), 5 PICA termination (3%), 7 direct arch origin (4%) and 3 occlusive lesion (2%) on the left. Prevalence rates of vertebral artery variations and occlusive lesions were reported, together with operative strategies and outcomes. Patients' age ranged from 35 to 88 (median 72), 122 were male and 115 had degenerative aneurysms. We report the results of preoperative vertebral artery evaluation by magnetic resonance angiography (MRA) and its impact upon operative strategy.Īmong the 214 patients who underwent thoracic aortic surgery from 2009 through 2012, 159 patients with preoperative MRA were retrospectively analysed. No commercial use is permitted unless otherwise expressly granted.Arterial variation is common in the vertebral artery, and simple occlusion of the left subclavian artery may result in brain infarction, especially when it terminates in the posterior inferior cerebellar artery (PICA). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. The proposed classification system aids in that selection.Īnastomosis aneurysm bypass flow diversion pipeline embolization device posterior inferior cerebellar artery vertebral artery. We present the first described cases of successful PED treatment of PICA aneurysms with direct placement of the PED in the PICA vessel itself. The PED may be used successfully to treat select aneurysms of the PICA. All PEDs were patent and all patients were independent at the last follow-up. Three patients had the PED placed entirely in the PICA and no patient suffered from a medullary or cerebellar stroke. All aneurysms were successfully treated, with 8/10 completely obliterated and 2 with a partial reduction in size. These were classified based on their morphology and location into two main types and five total subtypes for consideration of treatment with flow diversion. Vertebral aneurysms without disease in the PICA were excluded from the study.ġ0 PICA aneurysms were treated during the study period. PICA aneurysms were defined as aneurysms that involved the PICA. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases of PICA aneurysms treated with the PED. Institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with the PED. We assessed our multi-institutional experience treating these lesions, including the first reported cases of the PED placed within the PICA. Due to the unique anatomy and morphology of these aneurysms, it requires special attention. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. ![]() The pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results.
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