J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):201-206. 10.7461/jcen.2017.19.3.201.

Horizontal Stent Assisted Coiling of Wide Neck Basilar Tip Aneurysm: Comparison of Two Cases

• Kim YJ
• Sung JH
• Hong JT
• Lee SW

• KMID: 2393503
• DOI: http://doi.org/10.7461/jcen.2017.19.3.201

Abstract

Currently, endovascular coiling is a popular treatment for basilar tip aneurysms, which usually involve a wide neck. Serious complications can occur when the posterior cerebral artery (PCA) originating from a wide neck is not properly preserved. Accordingly, various adjunctive procedures using stents or a balloon have been introduced. Herein we report two cases of basilar tip aneurysms in which retrograde horizontal (from one PCA to the other PCA) stent-assisted coiling was successful, and we provide a summary of the important technical points.

Keyword

Aneurysm; Basilar artery; Embolization; Stent; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Basilar Artery
Neck*
Passive Cutaneous Anaphylaxis
Posterior Cerebral Artery
Stents*
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Serial angiography images of Case 1. (A) The 3D angiography of case 1 shows saccular aneurysm at basilar tip. The height of aneurysm is about 9 mm. (B) The roadmap view of case 1 shows relatively straight course of left Pcom and PCA. The Pcom size is about 1.9 mm. Compared to case 2, the navigation of microwire (and subsequent) mirocatheter is relatively easy. (C) The roadmap view of case 1 shows one stage navigation of microwire to right distal PCA (arrow). The microcatheter is ready to cross the aneurysm neck. (D) The roadmap view of case 1 shows successful deployment of Enterprise stent (arrows) and subsequent coiling via double microcatheters from left vertebral artery. (E) The final 3D angiography of case 1 shows complete coil packing into aneurysm with excellent preservation of both PCAs. PCA = posterior cerebral artery.

• 

  Fig. 2 Serial angiography images of Case 2. (A) The 3D angiography of case 2 shows small saccular aneurysm with at basilar tip. The height of aneurysm is about 2.8 mm. Compared to case 1, note the acute downward sagging course of left P1 segment (arrow), which make subsequent navigation difficult. (B) The roadmap view of case 2 shows V shaped kink of Pcom origin (arrow) and downward sagging of left P1 segment of PCA (triangle). They are big obstacle of navigation of mircowire and catheter. The Pcom size is over 2 mm. (C) The vertebral angiography of case 2 shows two stage navigation of microwire. The acute downward sagging of left P1 and short height of aneurysm make the microwire advance to proximal basilar artery firstly, rather than launch to right PCA directly (arrow). (D) The vertebral angiography of case 2 shows successful deployment of Enterprise stent (arrows) and partially deployed the 1st coil loop into aneurysm sac. After stent deployment, the downward sagging of left P1 is somewhat straightened. (E) The final 3D angiography of case 2 also shows complete packing. The inserted Enterprise stent makes the curved left PCA straight (arrows). PCA = posterior cerebral artery.

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