Endovascular Coiling of Ruptured Very Small Dissecting Fusiform Aneurysm of Posterior Inferior Cerebellar Artery with Parent Artery Preservation by Microcatheter Auto-Assistance.

Aneurysmal SAH (aSAH) secondary to ruptured small dissecting fusiform aneurysms of the posterior inferior cerebellar artery (PICA) is rare and particularly challenging. In these rare cases, different treatment strategies have been reported. We report two patients presenting with SAH secondary to small (3 and 4 mm) dissecting fusiform aneurysms located within 1 cm distally to PICA origin, treated with a novel endovascular approach. CLINICAL PRESENTATION: Two patients presented with SAH secondary to a very small ruptured fusiform aneurysm of the proximal section of PICA trunk. Both patients were treated by coil embolization combined with parent artery preservation by microcatheter auto-assistance. Both coiling procedures were uneventful, and the patients remained asymptomatic. Long-term follow-up angiography in both patients showed complete occlusion of the aneurysms with patency of the PICA.