J Cerebrovasc Endovasc Neurosurg.  2017 Jun;19(2):120-124. 10.7461/jcen.2017.19.2.120.

Kissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents

• Choo YS
• Lee CY

• KMID: 2393391
• DOI: http://doi.org/10.7461/jcen.2017.19.2.120

Abstract

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.

Keyword

Kissing aneurysm; Unruptured aneurysm; Basilar artery fenestration; Stent-assisted coiling; Coil embolization; Endovascular treatment

MeSH Terms

Aneurysm*
Basilar Artery*
Embolization, Therapeutic
Stents*

Figure

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  Fig. 1 3D rotational angiogram (A: posterior view, B: Rright lateral view) showed that two kissing aneurysms were adjoined with each other at the proximal junction of the fenestration incorporating both limbs of the basilar fenestration and both distal vertebral arteries. A single trunk of the right AICA - PICA originated from the right fenestrated limb. AICA = anterior inferior cerebellar artery; PICA = posterior inferior cerebellar artery.

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  Fig. 2 Coil embolization of kissing aneurysms was performed with dual-stents assistance in double-barrel configuration using two closed-cell stents (black arrows: Enterprise stent [Codman & Shurtleff, Raynham, MA, USA], white arrows: Solitaire AB stent [Covidien, Dublin, Ireland]).

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  Fig. 3 This schematic drawing shows the double-barrel dual closed-cell stents deployment (posteroanterior view). A Enterprise closed-cell stent (Codman Neurovascular) was deployed from the right limb of the basilar fenestration to the right parent VA. And a Solitaire AB stent (Covidien, Dublin, Ireland) was deployed form the left limb to the left VA. VA = vertebral artery.

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  Fig. 4 (A) The final anteroposterior and lateral angiogram showed complete obliteration of aneurysms and preservation of both fenestrated limbs as well as both parent vertebral arteries. (B) Angiography performed at the 1-year follow-up showed persistent complete obliteration of the aneurysms with both patent limbs and no evidence of in-stent stenosis.

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