Basilar Artery Trunk Aneurysm: Large Transitional Vertebrobasilar Artery Aneurysm Causing Severe Ischemic Cerebellar Stroke; Treatment with a Surpass Flow Diverter with Growing Thrombus, Increasing Mass Effect and Continued Contrast Medium Pooling in the Thrombus despite Angiographic Remodeling
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This chapter describes the treatment of a vertebrobasilar fusiform aneurysm, which was found in a 57-year-old male patient who presented with an acute ischemic stroke causing ataxia, dysarthria, and gait disturbance due to an infarct involving the SCA, AICA/PICA, and pontine perforator supply territories. The patient was treated by deploying a single long Surpass (Stryker) flow diverter from the basilar artery trunk to the right-hand V4 segment. During the same session, the distal V4 segment on the left-hand side was occluded with coils in order to prevent competing flow from this artery, creating an endoleak-like phenomenon. The procedure was well tolerated. An MRI/MRA follow-up examination showed a growing thrombus in the fusiform aneurysm with persistent contrast pooling. The main topics discussed in this chapter will be the evolution of this vicious disease with or without treatment and the different strategies and options available for treatment.
KeywordsBasilar artery Fusiform aneurysm Ischemic stroke Surpass flow diverter Deconstructive vertebral artery occlusion
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