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Basilar Artery Bifurcation Aneurysm: Giant Incidental Basilar Artery Bifurcation Aneurysm, Treated by Stent-Assisted Coil Occlusion Using Two Crossing pCONus1 Aneurysm Bridging Devices and Two Crossing Solitaire Stents Deployed in Telescoping Fashion; Four Treatment Sessions, Resulting in Permanent Aneurysm Occlusion and Good Clinical Outcome

  • Marta Aguilar Pérez
  • Muhammad AlMatter
  • Hans HenkesEmail author
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Abstract

A 25-year-old man presented with a 9-month history of headaches. CT and MRI/MRA revealed a giant, partially thrombosed aneurysm of the basilar artery bifurcation. The origins of both posterior cerebral arteries (PCA) and both superior cerebellar arteries (SCA) arose from the aneurysm sac, which developed from a diffuse enlargement of the basilar artery bifurcation and extended posteriorly. The attempt to catheterize the PCAs for a Y-stenting procedure failed. Access to the PCAs was not possible without crossing the aneurysm sac, which might have mobilized thrombus material from there downstream. In the first treatment session, two pCONus1 devices were implanted into the aneurysm sac in a crossing fashion. The stent petals defined a boundary between the aneurysm sac and the basilar artery bifurcation for the subsequent coil occlusion. Coil compaction required two additional treatment sessions. During the second procedure, the catheterization of the left PCA succeeded, and a Solitaire stent was deployed from there to the distal segment of the basilar artery trunk. The attempted access to the right PCA failed on the same day but was possible in the following third treatment session, which allowed the deployment of a second, crossing Solitaire stent from the right PCA to the trunk of the basilar artery. The reconstruction of the basilar artery bifurcation with two crossing pCONus1 devices and two crossing Solitaire stents allowed the complete and stable coil occlusion of the aneurysm sac. The entire aneurysm treatment was tolerated without a permanent neurological deficit. The combined use of multiple extra- and intrasaccular implants for the treatment of complex aneurysms is the main topic of this chapter.

Keywords

Basilar artery bifurcation Stent-assisted coil occlusion Crossing pCONus1 bifurcation stents Crossing Solitaire stents 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marta Aguilar Pérez
    • 1
  • Muhammad AlMatter
    • 1
  • Hans Henkes
    • 1
    Email author
  1. 1.Neuroradiologische KlinikNeurozentrum, Klinikum StuttgartStuttgartGermany

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