To analyze the safety and efficacy of interventional therapy for ruptured aneurysms of the distal posterior inferior cerebellar artery, and discuss the treatment strategies for the parent artery and accompanying vascular malformations.

The clinical data of 33 patients with hemorrhagic distal posterior inferior cerebellar artery aneurysm treated in the Department of Neurosurgery, Drum Tower Hospital, Nanjing University School of Medicine from January 2015 to March 2021 was collected. The patients were followed up upon 6 and 12 months postoperatively and received the cerebral angiography 6 months after the operation.

Thirty-three patients were confirmed with ruptured Distal-posterior inferior cerebellar artery (PICA) aneurysms. Among the 33 patients, 5 had multiple aneurysms at the distal end of PICA, 2 dissecting aneurysms, 3 pseudoaneurysms, 11 arteriovenous malformations (AVM), and 2 had a negative result by the first angiogram. Interventional embolization was successful in all patients，including 20 cases with coil embolization, 9 with Onyx/GLUBRAN biological glue, and 4 with coil plus Onyx. Bleeding was induced in 1 case during vascular superselection, another bleeding occurred when the catheter was removed. Extubation failed in 1 case with GLUBRAN embolization. One case had bleeding during embolization; hence, an emergency craniotomy was performed for decompression after hemostasis with Onyx embolization. There were 6 cases with cerebellar infarction after the operation: one case underwent decompression of the posterior fovea craniotomy 5 days after the operation; one case became mentally worse after the operation and limb muscle strength decreased; one case died of sudden brain herniation; and the remaining 3 cases did not have new symptoms. One case of brainstem infarction presented with bulbar palsy and facial paralysis. Among the patients with AVM, 5 cases were embolized simultaneously, of which, one case was treated by coil occlusion of the blood supply artery of AVM.1 case had secondary AVM embolization, and 2 cases had AVM resection after embolization. One case with naive AVM was not treated and was followed up. One patient died suddenly resulted from cerebral hernia. All aneurysms showed complete occlusion by angiography immediately after embolization. Upon 6 months, 28 cases were re-examined by angiography. One case of aneurysm recurred, and the rest of the aneurysms disappeared. Among the 30 cases of clinical follow-ups, no new neurological deficits were found. The modified Rankin Scale score was 0-2 in 27（90.0%）cases and 3-4 in 3 cases (10%).

Interventional embolization of distal PICA aneurysm is safe and effective, but the embolization material should be selected according to the specific characteristics of the aneurysm. Most patients with cerebellar vascular malformations can be embolized at the same time, but the strategy should be balanced according to the characteristics of the malformation and its relationship with the aneurysm.