Basilar Artery Bifurcation Aneurysm: Spontaneous SAH, Endovascular Coil Occlusion, Recurrent SAH, Multiple Retreatments, and Continued Recanalizations of a Growing Aneurysm

Abstract

A delayed hemorrhage after endovascular treatment of an intracranial aneurysm is a rare event. In this chapter, we describe the clinical and imaging findings of a 46-year-old female patient with a ruptured basilar artery bifurcation aneurysm who despite being treated by endovascular coil occlusion suffered a delayed re-rupture with subarachnoid hemorrhage (SAH) of the same aneurysm. The further treatment course was sobering with the aneurysm continuing to grow despite repeated endovascular treatments. Thus far, the patient has undergone a total of ten endovascular treatment sessions over the past 8 years, including stent-assisted coiling, neck-bridging flow diversion, and the usage of a variety of coil types from different manufacturers. Despite the two SAH episodes, one intracerebral hemorrhage after ventricular drain exchange, and the multiple treatments, the patient had a complete recovery, and there were no records of treatment-related permanent morbidities. The need for long-term follow-up after endovascular aneurysm treatment and the rational and safety of repeated endovascular treatments are the main topics of this chapter.