All patients underwent DSA and rotational angiography with 3D reconstructions to characterize the lesion and parent artery anatomy. Three patients had vertebral artery−PICA aneurysms, and the last patient had segmental stenosis of the vertebral artery harboring the origin of the PICA. Two of the 6 patients had a ruptured vertebral artery dissecting aneurysm involving the PICA origin. The ages of the patients ranged from 49 to 68 years with a mean of 54.8 years. The 6 patients, 4 men and 2 women, underwent placement of the self-expanding intracranial stent from the vertebral artery to the PICA. The purpose of this study was to report the feasibility, safety, and angiographic and clinical follow-up results of vertebral artery−PICA stent placement for various lesions in the 6 selected patients.īetween 20 in 3 referring hospitals in Korea, we performed stent placement in the vertebral artery−PICA in 6 cases. 7 Thereafter, we experienced 5 more cases in which vertebral artery−PICA stent placement was necessary. 4, 6 We reported the first case of vertebral artery−PICA stent placement for the preservation of patency of the PICA. 5 In particular, the use of stent devices in small intracranial vessels of ≤2-mm diameter is still controversial. 3, 4 In some circumstances, operators use those devices beyond the indications for use in the device manual. Recently, user-friendly, self-expanding intracranial stents have become available for the treatment of cerebral aneurysms and intracranial atherosclerotic disease. 2 Therefore, endovascular therapies by using only placement or coiling are often considered the first-line of treatment. Nevertheless, bypass surgery of the posterior circulation carries a considerable operative risk due to anastomosis in the deep and narrow operative corridor near the brain stem and cranial nerves.

1 If PICA flow compromise was expected or inevitable during or after treatment, revascularization of the PICA should be considered. Especially in the treatment of lesions involving the PICA origin, precautions should be taken against the possible risk of PICA occlusion because of the risk of ischemic complications in the eloquent brain stem territory. Vascular lesions of the vertebral artery and/or PICA, such as vertebral artery dissections, are not amenable to a surgical or endovascular approach. ABBREVIATIONS EVT endovascular treatment PCA posterior cerebral artery

Torn pica artery