Basilar Artery Bifurcation Aneurysm: A Ruptured Wide-Necked Basilar Bifurcation Aneurysm, Treated by Dual Comaneci-Assisted Coil Occlusion
- 94 Downloads
A ruptured wide-necked aneurysm arising from the bifurcation of the basilar artery (BA) was found in a 40-year-old male patient who presented with an acute subarachnoid hemorrhage (SAH). The origin of both posterior cerebral arteries (PCAs) arose from the base of the aneurysmal sac. Given the risk of rupture, and the unfavorable anatomical configuration of the aneurysm and its location, an endovascular approach was considered to be the best treatment option. The aneurysm was treated by coil occlusion involving temporary deployment of two Comaneci devices in order to support the coil cast and preserve the parent artery and both PCAs. The patient recovered fully with no new neurological deficit. Follow-up DSA examination at 3 and 12 months showed no evidence of the aneurysm having reoccurred, which is a risk if the coils compact enough after the procedure. Indeed, the DSA showed that the aneurysm had been completely obliterated, while both PCAs were still patent. The main topic of this chapter is the unique and safe application of two crossed Comaneci devices in a ruptured aneurysm with unfavorable anatomy. This eventually resulted in the aneurysm being completely obliterated, while the parent arteries arising from the aneurysmal neck remained patent.
KeywordsBasilar artery bifurcation Comaneci device Temporary stent-assisted coiling Wide-necked aneurysm
- Bang JS, Kim CH, Kwon BJ, Park SC, Kim Y. The difficulties and risks of Y-stent-assisted coiling: a comparison of first and second stenting procedures. World Neurosurg. 2016;88:146–53. .
- Bohnstedt BN, Ziemba-Davis M, Sethia R, Payner TD, DeNardo A, Scott J, Cohen-Gadol AA. Comparison of endovascular and microsurgical management of 208 basilar apex aneurysms. J Neurosurg. 2017;127(6):1342–52. .
- Chalouhi N, Jabbour P, Gonzalez LF, Dumant AS, Rosenwasser R, Starke RM, Gordon O, 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. Neuro-Surgery. 2012;71(4):785–94
- Fischer S, Weber A, Carolus A, Drescher F, Götz F, Weber W. Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience. J Neurointerv Surg. 2017;9(11):1039–97. .
- Henkes H, Weber W. The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol. 2015;25(Suppl 2):317–24. .
- Jiang B, Paff M, Colby GP, Coon AL, Lin LM. Cerebral aneurysm treatment: modern neurovascular techniques. Stroke Vasc Neurol. 2016;1(3):93–100. .
- Lawson AL, Chandran A, Puthuran M, Goddard T, Nahser H, Patankar T. Initial experience of coiling cerebral aneurysms using the new Comaneci device. J Neurointerv Surg. 2016;8(8):e32. .
- Meilán Martínez A, Murias Quintana E, Gil García A, Vega Valdés P, Saiz AA. Assisted techniques for the endovascular treatment of complex or atypical cerebral aneurysms. Radiologia. 2013;55(2):118–29. .
- Saliou G, Sacho RH, Power S, Kostynskyy A, Willinsky RA, Tymianski M, terBrugge KG, Rawal S, Krings T. Natural history and management of basilar trunk artery aneurysms. Stroke. 2015;46(4):948–53. .
- Sirakov S, Sirakov A, Hristov H, Minkin K, Penkov M, Karakostov V. Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms. J Neurointerv Surg. 2018; . pii:neurintsurg-2017-013641
- Tjahjadi M, Kim T, Ojar D, Byoun HS, Lee SU, Ban SP, Hwang G, Kwon OK. Long-term review of selected basilar-tip aneurysm endovascular techniques in a single institution. Interdisciplinary Neurosurg. 2017;8:50–6.