Basilar Artery Trunk Aneurysm: Unruptured Saccular Aneurysm of the Distal Basilar Artery Trunk at the Origin of the Left Superior Cerebellar Artery with Brainstem Compression, LEO Stent-Induced Flow Diversion of the Aneurysm with Resolution of the Mass Effect and No Perforator Occlusion, and Good Clinical Outcome with Midterm Follow-Up
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An 80-year-old female patient presented with a persistent occipital headache over the course of a year, with no clear cause. She had no focal neurological deficit on clinical examination. An MRI scan showed a large 19 mm unruptured saccular aneurysm of the distal basilar artery (BA) at the origin of the left superior cerebellar artery (SCA) with compression of the subjacent pons. DSA confirmed the presence of a thrombosed dissecting saccular aneurysm of the distal BA, with its neck incorporating the origin of the left SCA. In order to remodel the aneurysm, to reduce rupture risk, and to decrease mass effect, a flow diverting stent was inserted. To reduce the risk of basilar perforator and posterior circulation side-branch vessel occlusion, a higher-porosity LEO stent was placed rather than a lower-porosity flow diverting stent. Repeated MRI/MRA examinations at 3 and 12 months confirmed the successful treatment of the aneurysm, with a sustained reduction in size and mass effect. The current treatment considerations for aneurysms located within the basilar artery territory and reaching a balance between flow diversion and the risk of perforator infarction is the main topic of this chapter.
KeywordsBasilar artery Dissecting saccular aneurysm Endovascular treatment Flow diverting stents Perforator occlusion Neointimal endothelialization LEO stent Compression of the pons Risk of perforator infarction Clopidogrel Remodeling of the parent vessel Low porosity Increased porosity Neo-endothelialization Particle imaging velocimetry LEO baby Higher-porosity stents
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