Objective:

Background:

Aneurysms of the posterior fossa, in particular the posterior inferior cerebellar artery (PICA), are rare and technically challenging lesions to treat due to their eloquent location and complex morphology. Traditional microsurgical and endovascular approaches have provided varying results over the years. Flow-diverting stents (FDS), particularly newer-generation devices like the Pipeline Vantage with Shield Technology, offer a promising alternative in select cases.

Design/Methods:

We present a case series of three patients with PICA aneurysms treated with the Pipeline Vantage 021 Embolization Device. One patient had a ruptured proximal PICA aneurysm treated with staged endovascular therapy after stabilization. The remaining two patients had incidentally discovered unruptured proximal PICA aneurysms and underwent elective flow diversion. All patients received dual antiplatelet therapy and underwent interval follow-up digital subtraction angiography.

Results:

All three cases resulted in technically successful deployment of the Pipeline Vantage 021 device, with no intraprocedural complications. One patient experienced a delayed cerebellar infarction but recovered well with no long-term deficits. Follow-up angiography after 6 months demonstrated complete aneurysm obliteration in all cases. One patient developed moderate in-stent stenosis without clinical symptoms. No cases of braid deformation, rebleeding, in-stent thrombosis, or delayed aneurysm rupture were observed.

Conclusions:

Our early experience supports the safety and efficacy of the Pipeline Vantage 021 flow diverter in treating PICA aneurysms, including ruptured and unruptured lesions. This series adds to the limited literature supporting flow diversion in the posterior circulation and highlights the importance of patient selection, periprocedural management, and close follow-up.