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Research ArticleNeurointervention

Prepontine Cistern Filling Independently Predicts Poor Neurologic Outcomes in Ruptured PICA Aneurysms

Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon and Aurélien Nouet
American Journal of Neuroradiology May 2025, 46 (5) 929-935; DOI: https://doi.org/10.3174/ajnr.A8615
Etienne Lefevre
aFrom the Department of Neurosurgery (E.L., P.B., A.L.B., A.C., A.N.), Pitié-Salpêtrière Hospital, APHP, Paris, France
bSorbonne Université (E.L., S.L., A.J., V.D., F.C.), UPMC, Paris, France
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  • ORCID record for Etienne Lefevre
Paul Brugerolles
aFrom the Department of Neurosurgery (E.L., P.B., A.L.B., A.C., A.N.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Kévin Premat
cDepartment of Interventional Neuroradiology (K.P., S.L., E.S., F.C.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Stéphanie Lenck
bSorbonne Université (E.L., S.L., A.J., V.D., F.C.), UPMC, Paris, France
cDepartment of Interventional Neuroradiology (K.P., S.L., E.S., F.C.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Eimad Shotar
cDepartment of Interventional Neuroradiology (K.P., S.L., E.S., F.C.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Alice Jacquens
bSorbonne Université (E.L., S.L., A.J., V.D., F.C.), UPMC, Paris, France
dDepartment of Anesthesia and Intensive Care (A.J., V.D.), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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Vincent Degos
bSorbonne Université (E.L., S.L., A.J., V.D., F.C.), UPMC, Paris, France
dDepartment of Anesthesia and Intensive Care (A.J., V.D.), Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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Anne Laure Boch
aFrom the Department of Neurosurgery (E.L., P.B., A.L.B., A.C., A.N.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Alexandre Carpentier
aFrom the Department of Neurosurgery (E.L., P.B., A.L.B., A.C., A.N.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Frédéric Clarencon
bSorbonne Université (E.L., S.L., A.J., V.D., F.C.), UPMC, Paris, France
cDepartment of Interventional Neuroradiology (K.P., S.L., E.S., F.C.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Aurélien Nouet
aFrom the Department of Neurosurgery (E.L., P.B., A.L.B., A.C., A.N.), Pitié-Salpêtrière Hospital, APHP, Paris, France
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Abstract

BACKGROUND AND PURPOSE: Ruptured PICA aneurysms present considerable treatment challenges due to their rarity and proximity to critical neurovascular structures. This study aims to report and critically analyze the long-term neurologic outcomes of patients with ruptured PICA aneurysms treated at our tertiary center and to evaluate the prognostic value of prepontine cistern filling grade on initial CT scans.

MATERIALS AND METHODS: Clinical and radiologic data were retrospectively collected for consecutive patients with ruptured PICA aneurysms treated at our institution between January 2010 and December 2021. The prepontine cistern filling was graded from 0–3 on sagittal slices of the initial CT scan by 2 independent readers.

RESULTS: Fifty-seven patients with ruptured PICA aneurysms were included. The mean aneurysm diameter was 7.2 mm (SD ± 4.9), with a mean radiologic follow-up of 40.2 months (SD ± 45.2). Endovascular treatment was the primary technique (96.5%), with a small number (3.5%) requiring microsurgical clipping. Parent vessel sacrifice was performed in 49% of cases. Complete aneurysm occlusion was achieved in 79% of patients, with a recurrence rate of 19%. External ventricular drainage was necessary in 83% of patients, and 28% later required a permanent ventricular shunt. Symptomatic vasospasm occurred in 37% of patients. The in-hospital mortality rate was 11%, and 55% of survivors required a transient tracheostomy. At 1-year posthemorrhage, 60% had a good neurologic outcome. Multivariate analysis revealed that poor neurologic outcomes were significantly associated with higher grade of prepontine cistern filling (P < .05) and in those whose parent vessel had to be sacrificed (P < .05).

CONCLUSIONS: Ruptured PICA aneurysms carry a grim prognosis and pose major management challenges. Both the grade of prepontine cistern filling on initial CT scan and the need for parent vessel sacrifice are important prognostic factors.

ABBREVIATIONS:

GCS
Glasgow Coma Scale
IQR
interquartile range
WFNS
World Federation of Neurosurgical Societies
  • © 2025 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 46 (5)
American Journal of Neuroradiology
Vol. 46, Issue 5
1 May 2025
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Cite this article
Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon, Aurélien Nouet
Prepontine Cistern Filling Independently Predicts Poor Neurologic Outcomes in Ruptured PICA Aneurysms
American Journal of Neuroradiology May 2025, 46 (5) 929-935; DOI: 10.3174/ajnr.A8615

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Neurological prognosis of ruptured PICA aneurysms
Etienne Lefevre, Paul Brugerolles, Kévin Premat, Stéphanie Lenck, Eimad Shotar, Alice Jacquens, Vincent Degos, Anne Laure Boch, Alexandre Carpentier, Frédéric Clarencon, Aurélien Nouet
American Journal of Neuroradiology May 2025, 46 (5) 929-935; DOI: 10.3174/ajnr.A8615
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