title: Retrograde access to the posterior inferior cerebellar artery in balloon-assisted coiling of posterior inferior cerebellar artery aneurysms.
abstract: BACKGROUND
  Balloon-assisted coil embolization of proximal posterior inferior cerebellar artery (PICA) aneurysms may be limited by the inferiorly oriented, acutely angulated origin of the PICA from the vertebral artery. The aim of this study is to evaluate retrograde access to the PICA via the contralateral vertebral artery or the posterior communicating artery.
  
  
  METHODS
  Twenty-nine proximal PICA aneurysms treated by balloon remodeling with navigation of the balloon in the PICA via the contralateral vertebral artery or posterior communicating artery were found in our database between January 2007 and December 2013 and were reviewed.
  
  
  RESULTS
  Access to the PICA was made via the contralateral vertebral artery in 26 patients (90%), six of them (23%) with a hypoplastic V4 segment. In three patients (10%) the retrograde approach was made via the posterior communicating artery. After balloon remodeling, additional stenting was performed in 16 patients (55%). The complication rate was 3% (1 acute stent thrombosis). Grade 0 or 1 occlusion was obtained in all patients at completion angiography. No recurrence was found during follow-up.
  
  
  CONCLUSIONS
  Retrograde access to the PICA to perform balloon-assisted coil embolization of proximal PICA aneurysms with or without additional stenting after coiling is safe and effective. Hypoplastic V4 segment of the contralateral vertebral artery is not a contraindication.
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany Department of Radiology, UZ Leuven, Leuven, Belgium Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany.
authors.forename: Christian Paul
authors.initials: CP
authors.lastname: Stracke
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Nordmeyer
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Heddier
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stauder
authors.affiliation: Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Chapot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D002531:Cerebellum / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011859:Radiography
keywords: Aneurysm; Balloon; Brain; Coil; Embolic