{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:57:31Z","timestamp":1784829451563,"version":"3.55.0"},"reference-count":13,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"abstract":"\n Background<\/jats:title>\n Dissecting pseudoaneurysms of the posterior inferior cerebellar artery (PICA) are rare, high-risk lesions with outcomes heavily influenced by anatomical location. This study evaluates the relationship between PICA segmental anatomy, endovascular treatment strategy, and clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 21 patients with dissecting PICA aneurysms treated endovascularly between 2013 and 2025. Aneurysms were anatomically classified by segment (P1\u2013P5); P3 was further subdivided into P3A (proximal to the PICA loop) and P3B (distal to the loop). Primary outcome was discharge modified Rankin Scale (mRS\u2009\u2264\u20092; classified as favorable). Secondary outcomes included ischemic stroke and segment-specific treatment trends.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 21 patients, 16 (76%) were female and 13 (62%) were White; mean age was 57.3\u2009\u00b1\u200915.5 years. Most aneurysms were small (<7 mm,\n n<\/jats:italic>\n \u2009=\u200916, 76%), ruptured (\n n<\/jats:italic>\n \u2009=\u200917, 81%), and located in proximal segments (P1\u2013P3,\n n<\/jats:italic>\n \u2009=\u200914, 67%). Hypertension was present in 11 (52%) and intraventricular hemorrhage (IVH) in 12 (57%). Treatments included coiling (\n n<\/jats:italic>\n \u2009=\u200910, 48%), Onyx embolization (\n n<\/jats:italic>\n \u2009=\u20095, 24%), flow diversion (\n n<\/jats:italic>\n \u2009=\u20092, 10%), and adjunctive techniques (\n n<\/jats:italic>\n \u2009=\u20093, 14%). Deconstructive strategies were used in 14 (67%). Favorable outcome (mRS\u2009\u2264\u20092) was achieved in 15 (71%). Clinically silent cerebellar strokes occurred in 9 (43%); no brainstem infarctions were seen. IVH was significantly associated with poor outcome (\n p<\/jats:italic>\n \u2009=\u20090.043). All P3A cases (\n n<\/jats:italic>\n \u2009=\u20093) had favorable outcomes, while 2 of 4 P3B cases (50%) were unfavorable.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n PICA segment anatomy predicts treatment safety. Reconstructive strategies are preferred for proximal lesions (P1\u2013P3A); deconstructive methods are safe and effective beyond the PICA loop (P3B\u2013P5).<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/15910199251370829","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T12:46:54Z","timestamp":1756730814000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Tailoring endovascular strategy to posterior inferior cerebellar artery segment anatomy: Avoiding brainstem infarction in dissecting pseudoaneurysms"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-0599","authenticated-orcid":false,"given":"Mustafa","family":"Ismail","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norito","family":"Kinjo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2005-5781","authenticated-orcid":false,"given":"Ariana","family":"Chacon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3138-3484","authenticated-orcid":false,"given":"Julio","family":"Isidor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Bani Saad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Al-Kindy Teaching Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasna","family":"Loulida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuroendovascular Surgery Division, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2004.01.007"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2014"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199808000-00107"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2013.08.005"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s007010050337"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/159101990100700312"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/JNS\/2008\/109\/7\/0023"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1591019920968349"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.25259\/SNI_576_2021"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1757432"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2015-011732"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.06.054"}],"container-title":["Interventional Neuroradiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15910199251370829","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15910199251370829","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15910199251370829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:57:15Z","timestamp":1777460235000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15910199251370829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":13,"alternative-id":["10.1177\/15910199251370829"],"URL":"https:\/\/doi.org\/10.1177\/15910199251370829","relation":{},"ISSN":["1591-0199","2385-2011"],"issn-type":[{"value":"1591-0199","type":"print"},{"value":"2385-2011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"article-number":"15910199251370829"}}