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Endovasküler tedavi uygulanan posterior inferior serebellar arter (PICA) anevrizmalarının klinik değerlendirilmesi

Amaç: PICA (posterior inferior serebellar arter) anevrizmaları nadir intrakranial anevrizmalar olup olguların önemli bir kısmı kanama ile prezente olur. Özellikle son iki dekadda PICA anevrizmalarının tedavisinde daha çok endovasküler yöntemler öne çıkmaktadır. PICA orijininin anatomik yapısından dolayı endovasküler ve cerrahi tedavide güçlükler yaşanmaktadır. Gereç ve Yöntemler: Bu çalışmada Ankara Numune Eğitim ve Araştırma Hastanesinde 2014-2018 yılları arasında endovasküler yöntemlerle tedavi edilen 17 PICA anevrizma olgusunun klinik ve anjiyografik özellikleri incelenmektedir. Bulgular: Toplam 17 olgunun 15’i bayan 2’si erkek olup yaş ortalamaları 53.5 olarak tespit edilmiştir. Dört olguda eşlik eden diğer inrakranial lokalizasyonlarda anevrizmaya rastlanmıştır. Olguların dördünde anevrizma fuziform disekan tipte iken diğer 13 olguda anevrizma saküler tipte idi. Fuziform disekan anevrizmaların çap ortalamaları 8.5 mm iken saküler tip anevrizmaların çap ortalaması ise 11.4 mm idi. Toplam 2 olguda primer koilleme yapılırken, 5 olguda stent eşliğinde koilleme ve ikisi çift seans olmak üzere toplam 10 olguda akım yönlendiriciler tedavide kullanılmıştır. Sonuç: Bu çalışmada PICA anevrizması nedeni ile tedavi edilen 17 olguda sıklıkla akım yönlendiricilerin tercih edildiği endovasküler tedaviler ile başarılı klinik sonuçlar elde edilmiştir.

Anahtar Kelimeler:

PICA anevrizması, endovasküler tedavi, akım yönlendiriciler, anjiyografi

Clinical evaluation of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms

Aim: PICA aneurysms are rare. A significant proportion of the patients present with hemorrhage. Endovascular treatment is replacing the surgical treatment particularly within the last two decades. Anatomical difficulties of the PICA origin is the reason of disfficulties in surgical and endovascular treatment options.Material and Methods: In the present study, clinical and angiographical analysis of 17 patients with PICA aneurysms whom were treated at Ankara Numune Education and Research Hospital between 2014 and 2018 were analyzed.Results: Of 17 patients 15 were female and two of them were male. Four patients had associated aneurysms at other intracranial localizations. Aneurysms were saccular in 13 and fusiform dissecting in 4 patients. Mean diameter of the aneurysms was 8.5 mm in fusiform dissecting type and 11.4 mm in saccular type. Primary coiling was performed in 2, stent assisted coiling in 5 and flow diverter treatment was primary treatment modality in 10 patients. Conclusion: In the present study of 17 PICA aneurysms, flow diverters were the main treatment modality among endovascular treatment options with improved clinical results.

Keywords:

PICA aneurysm, endovascular treatment, flow diverters, angiography,

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