Sister diagnosed with right PICA aneurysm... Now What?!

General
1

Hi All.

First, let me say thank you for this forum. It's inspiring to see the support.

I hope this is the right place for my questions.

My 36 years old sister was just diagnosed with an 8 mm aneurysm on her right PICA.

One doctor sounded trigger-happy about coiling the right PICA altogether.
Another one scared us completely about the side effects of such a step and suggested a stent assisted coiling of the aneurysm.
Both suggested exploratory endovascular procedure.

So naturally - we are all hysterical.

Any advice on how to choose a surgical approach?

Who would be the "best doctor in the world" for 2nd opinion on this?

Thank you,

Gil, a worried brother

2

Gil,

I had my 7.3 mm ACOM aneurysm coiled and stented in Feb. I think this procedure is determined by multiple factors, opening size, age of the patient, issues of brain accessibility. I saw two of the best doctors in Boston, Christopher Oglivy and Aman Patel. The latter performed my surgery.

3

Hi Gil, Your sister has an aneurysm in an unusual place. Only .5 to 3 % of aneurysms are in PICA. That is where my husband’s aneurysm was. Unfortunately his ruptured and he had a craniotomy to clip it. 2Fight on this site also had a PICA aneurysm. This is survivable. You will get through it. Hoping for healing.

4

Hi Campanile & Judy

Thanks for the quick support. Hope all is well.

I will certainly put Dr Oglivy & Dr Patel on the list for my sister to contact.

With regards to coiling - I am mostly concerned with possibility for rupture & chances of recurrence.

Clipping scares us even more - what parts of the brain we sacrifice is unknown.

Can you share your experience regarding the surgeries aftermath / side effects?

Gil

5

I had a 6mm aneurysm near my brain stem rupture and it was coiled with great results. Trust me, she should do something before a rupture. It will be MUCH less trauma!

6

Gil,



I had more issues with the intubation for anesthesia than I had with the endovascular coiling. In fact, the coiling was easier on me than the angiogram I had prior to the surgery.



Brain surgery is scary, rupture scarier. I opted for the first choice.

7

Gil,

I had a ruptured aneurysm in the right PICA. The size was 10mm by 6mm. It was coiled. As it is unruptured, your Sister has options on technique. In my case, I had no choice but an emergency procedure and I was lucky that I had an amazing Neuro-Surgeon on staff at my local hospital who skilled in both techniques. I do not want to worry your Sister in describing my post issues but want to give a positive message that I survived and was able to now somewhat manage my post issues. As your Sister's Annie is unruptured, it gives your Sister time for the best solution. Cerebellum/brain stem (PICA, AICA, SCA, and Basilar) aneurysm are the rare Annie case, the Neurosurgeon should be skilled in Neck/Brain surgery. The reason for stent assisted coiling is that it helps stabilize the coiling as the artery feeds off the neck artery. (I am not sure but these are the questions to ask the Neuro-Surgeon). During Aneurysm Awareness walk in the Bay Area, I met an Aneurysm survivor (unruptured) like your Sister who traveled from the MidWest to have Dr. Lawton of UCSF for her procedure. UCSF pioneered most of the advanced procedures.

I can give only positive messages to your Sister and encouragement that she will be a Survivor

8

Hi 2Fight,

Thanks for your encouragement. We stay positive & keep our heads high.

We thank god for finding it by accident before it ruptured - it gives us time & options.

Now we focus on finding the best doctor for the job.
We met the top neurosurgeons in Israel, but even they have very limited experience with PICA aneurysms.

So I guess we're looking for a world-class doctor, who's done this procedure a million time, at 100% success, with the best equipment possible ;)

Gil

9

Gil,

My Neuro-Surgeon was Dr. Jeffrey Thomas. He saved my life with a ruptured PICA Aneurysm. He is a great Neuro-Surgeon who treats patients at a human level.

https://www.mywtmf.com/fremont-neurosurgeon-jeffrey-thomas.html

UCSF Dr. Michael Lawton and Dr. Christopher Dowd are world renowned.

http://neurosurgery.ucsf.edu/index.php/about_us_faculty_lawton.html

https://www.ucsfhealth.org/christopher.dowd

The following is a good tutorial of the PICA so you and your Sister can be informed

http://neuroangio.org/anatomy-and-variants/pica/

Hope the best. Your Sister deserves the best. Message me offline if you want more personal information.

10

If you are looking internationally, my husband’s neurosurgeon was Dr. Fraser Saunders at Kingston General Hospital in Canada.

11

I had a 8 mm right pica unruptured aneurysm treated with the pipeline flex up at NYU with Dr. Howard Riina a year ago On July 21. If you would like any other information, Just friend me and we can be in touch that way. Good luck with your sister-- it is treatable, but you have to find the right surgeon that is familiar with this area, as Pica aneurysms are rare.

12

I don’t know too many people on here w/ a PICA annie, but I have come across a few along the way. You could also check wit" lady" – – the last time I checked, she still had an untreated, unruptured right pica aneurysm. She may be able to tell you what she’s found out so far in trying to come up with a treatment option. Please let us know the latest developments on your sister when you have a chance. Best of luck, Patty