Abstract:ObjectiveTo investigate the safety and efficacy of endovascular embolization for ruptured posterior inferior cerebellar artery （PICA） aneurysms. MethodsThe clinical data of 18 patients with ruptured PICA aneurysms admitted in Nanjing First Hospital from June 2014 to August 2021 were retrospectively analyzed. ResultsImmediate postoperative angiography showed that 14 patients （77.78%） had Raymond grade Ⅰ dense embolism, 2 patients （11.11%） had Raymond grade Ⅱ residual tumor neck, and 2 patients （11.11%） had Raymond grade Ⅲ residual tumor. Perioperative complications occurred in 2 cases （11.11%）, and cerebral stem and cerebellar infarction resulted in death in 1 case （5.56%）. One patient （5.56%） with ruptured aneurysm ruptured again during the operation. Except for 1 died patient, the mRS scores of 17 patients were all ≤3 points, and the good prognosis rate was 94.44% （17/18）. Seventeen patients were followed up for 6-12 months after operation, 2 patients with PICA tumor neck recurrence after simple coil embolization, the recurrence rate was 11.11% （2/18）, one of them was cured by LVIS double stent treatment. ConclusionEndovascular embolization is a safe and effective method for the treatment of PICA aneurysms. The design of treatment strategy should be based on the location and morphological characteristics of the aneurysm and parent artery.