J Cerebrovasc Endovasc Neurosurg.  2023 Mar;25(1):81-86. 10.7461/jcen.2022.E2022.03.005.

Stent-assisted coiling of a ruptured basilar artery perforator aneurysm: A case report

• Cho J
• Suh SH
• Chung J

• KMID: 2540811
• DOI: http://doi.org/10.7461/jcen.2022.E2022.03.005

Abstract

Basilar artery (BA) perforator aneurysms are exceedingly rare causes of subarachnoid hemorrhage. Therefore, the natural history and optimal treatment have not been established, and surgical, endovascular, and conservative management have been used. However, there is no consensus on the optimal treatment strategy. Herein, we report the case of a 52-year-old man presenting with a ruptured BA perforator aneurysm. First, we deployed an Enterprise stent from the left P1 segment to the BA because the microcatheter could not enter the aneurysm. Then, we deployed a helical coil on the orifice of the BA perforator. Finally, we deployed another Enterprise stent, sandwiching the helical coil between the two Enterprise stents. The aneurysm was completely obliterated without recurrence on the follow-up angiography. Our technique of sandwiching the small helical coil between two Enterprise stents might help other surgeons by offering another feasible treatment option for ruptured BA perforator aneurysms.

Keyword

Basilar artery aneurysm; Endovascular procedure; Stent; Subarachnoid hemorrhage

Figure

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  Fig. 1. (A) Brain computed tomography (CT) reveals subarachnoid hemorrhage (SAH) within the basal, interpeduncular, and perimesencephalic cisterns. Initial CT angiography and transfemoral cerebral angiography (TFCA) fail to reveal the SAH source. (B) The three-day follow-up TFCA and (C) three-dimensional reconstruction image reveal an aneurysm (white arrow) arising from a small perforating branch of the basilar artery with delayed contrast filling.

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  Fig. 2. (A) The microcatheter (Excelsior SL-10; Stryker Neurovascular, Kalamazoo, MI, USA) cannot enter the aneurysm. Therefore, a closed-cell stent (Enterprise; Codman Neurovascular, Miami Lakes, FL, USA) is deployed from the left P1 segment to the basilar artery. White arrowheads indicate the proximal and distal ends of the Enterprise stent. Then, a helical coil (Target Helical Ultrasoft; Stryker Neurovascular, Freemont, CA, USA) is deployed on the orifice of the basilar artery perforator where the aneurysm had arisen. Finally, another Enterprise stent is deployed, sandwiching the helical coil between the two Enterprise stents. (B) The posterior view of a three-dimensional reconstruction image reveals that the coil was placed on the orifice of the perforator, and the aneurysm disappeared. (C) Three days after the treatment, magnetic resonance diffusion-weighed imaging reveals a recent perforator infarction on the left lower midbrain with multifocal high signal lesions in the cerebellum. (D) Follow-up transfemoral cerebral angiography 3 and (E) 12 months after surgery reveal complete obliteration of the aneurysm without recurrence.

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