Basilar Artery Bifurcation Aneurysm: Retrograde Access via the Posterior Communicating Artery to the Basilar Artery Bifurcation for Stent-Assisted Recoiling of a Wide-Necked Aneurysm
- 85 Downloads
A 42-year-old female patient was treated for acute subarachnoid hemorrhage (SAH) due to the rupture of a broad-based aneurysm on the basilar artery (BA) bifurcation. The aneurysm was occluded with coils in the acute phase using a balloon-remodeling technique and a neck remnant was intentionally left because the neck could not be fully controlled without implanting a stent. The follow-up DSA 6 months later showed that the coils had compacted and the aneurysm had grown. Since the wide neck of the aneurysm included both P1 segments of the posterior cerebral arteries (PCAs), using a single stent which would cover just one of the P1 segments would not have provided sufficient control of the aneurysm neck. Due to coil loops near the aneurysm base, neither an intra-aneurysmal stent nor an intrasaccular occlusion device were considered feasible. The patient’s prominent posterior communicating artery (PcomA) on the right-hand side was clearly visible on CTA and DSA images. The aneurysm was retreated by placing a 2/18 mm LEO+ Baby stent (Balt Extrusion) from the left P2/P1 segment and the BA bifurcation to the right P1 segment with access from the ICA/PcomA on the right-hand side, followed by additional coil occlusion. The procedure was carried out under general anesthesia with no technical or clinical complications, and the patient was discharged home 2 days after the treatment. MRI/MRA follow-up after 6 months showed a stable aneurysm occlusion. Stent-assisted coil occlusion of basilar artery bifurcation aneurysms with access via the PcomA as a technical nuance is the main topic of this chapter.
KeywordsBasilar artery bifurcation aneurysm Stent-assisted coiling Posterior communicating artery access LEO+ Baby
- Aydin K, Sencer S, Barburoglu M, Berdikhojayev M, Aras Y, Sencer A, İzgi N. Midterm results of T-stent-assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents. J Neurosurg. 2017;127(6):1288–96. .
- Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S. Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases. Neurosurgery. 2012;71(4):785–94. .
- Cho YD, Kim KM, Lee WJ, Kang HS, Kim JE, Han MH. Retrograde stenting through the posterior cerebral artery in coil embolization of the posterior communicating artery aneurysm. Neuroradiology. 2013;55(6):733–9. .
- Darsaut TE, Costalat V, Salazkin I, Jamali S, Berthelet F, Gevry G, Roy D, Raymond J. Fatal avulsion of choroidal or perforating arteries by guidewires. Case reports, ex vivo experiments, potential mechanisms and prevention. Interv Neuroradiol. 2014;20(3):251–60. .
- Fargen KM, Mocco J, Neal D, Dewan MC, Reavey-Cantwell J, Woo HH, Fiorella DJ, Mokin M, Siddiqui AH, Turk AS, Turner RD, Chaudry I, Kalani MY, Albuquerque F, Hoh BL. A multicenter study of stent-assisted coiling of cerebral aneurysms with a Y configuration. Neurosurgery. 2013;73(3):466–72. .
- Feng MT, Wen WL, Feng ZZ, Fang YB, Liu JM, Huang QH. Endovascular embolization of intracranial aneurysms: to use stent(s) or not? Systematic review and meta-analysis. World Neurosurg. 2016;93:271–8. .
- Henkes H, Bose A, Felber S, Miloslavski E, Berg-Dammer E, Kühne D. Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (Neuroform). Interv Neuroradiol. 2002;8(2):107–19. .
- Nakahara I, Handa H, Nishikawa M, Koide T, Yamakawa H, Inagawa S, Kojima M. Endovascular coil embolization of a recurrent giant internal carotid artery aneurysm via the posterior communicating artery after cervical carotid ligation: case report. Surg Neurol. 1992;38(1):57–62.
- Phan K, Huo YR, Jia F, Phan S, Rao PJ, Mobbs RJ, Mortimer AM. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms. J Clin Neurosci. 2016;31:15–22. .
- Pierot L, Gubucz I, Buhk JH, Holtmannspötter M, Herbreteau D, Stockx L, Spelle L, Berkefeld J, Januel AC, Molyneux A, Byrne JV, Fiehler J, Szikora I, Barreau X. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 study. AJNR Am J Neuroradiol. 2017;38(6):1151–5. .
- Saeki N, Rhoton AL Jr. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg. 1977;46(5):563–78. .
- Sugiyama S, Niizuma K, Sato K, Rashad S, Kohama M, Endo H, Endo T, Matsumoto Y, Ohta M, Tominaga T. Blood flow into basilar tip aneurysms: a predictor for recanalization after coil embolization. Stroke. 2016;47(10):2541–7. .
- Tsurumi A, Tsurumi Y, Negoro M, Tsugane S, Ryuge M, Susaki N, Fukuoka T, Miyachi S. Delayed rupture of a basilar artery aneurysm treated with coils: case report and review of the literature. J Neuroradiol. 2013;40(1):54–61. .