• Hyung-Gyu Jang and Jung-Soo Park.
• Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea.
• Medicine (Baltimore). 2021 Dec 17; 100 (50): e28260e28260.

RationaleDistal posterior inferior cerebellar artery (PICA) aneurysms are extremely rare. Herein, we describe a case of PICA pseudoaneurysm with proximal occlusion achieved using detachable coils, but antegrade recanalization, which showed a normal PICA configuration on follow-up angiography. Possible mechanisms of the recanalization and lesions are also discussed.Patient ConcernsThe patient was an 80-year-old woman with a subarachnoid hemorrhage (SAH) resulting from a distal PICA-ruptured aneurysm, initially misdiagnosed as a non-aneurysmal traumatic SAH.DiagnosisOn hospitalization day 10, the patient developed rebleeding, and brain computed tomography angiography confirmed a distal PICA pseudoaneurysm.InterventionEndovascular coil embolization was performed. Inevitably, the proximal PICA was occluded using detachable coils, and complete occlusion of the affected PICA was confirmed on the final angiogram.OutcomeFortunately, the patient recovered fully without any neurological sequelae. One year after the procedure, a follow-up angiography was performed, which revealed recanalization of the previously occluded PICA, with normal configuration and no visible aneurysmal dilatation.ConclusionEven if the SAH is scanty and predominantly in the perimesencephalic cistern, performing a catheter-based angiography is essential. In the case of proximal occlusion of the parent artery without internal trapping in endovascular treatment of PICA pseudoaneurysm, follow-up examination with a short-term angiography might be crucial.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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